Healthcare Provider Details

I. General information

NPI: 1518962034
Provider Name (Legal Business Name): PATRICIA A TRAFFORD P.A.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 09/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 N MAIN ST
PROVIDENCE RI
02904-5706
US

IV. Provider business mailing address

3 OPHELIA ST
PROVIDENCE RI
02909-5820
US

V. Phone/Fax

Practice location:
  • Phone: 401-455-3574
  • Fax: 401-455-3624
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA00024
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: