Healthcare Provider Details

I. General information

NPI: 1285815993
Provider Name (Legal Business Name): EAST SIDE PEDIATRICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2007
Last Update Date: 01/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 NEWMAN AVE FL 1
RUMFORD RI
02916-1945
US

IV. Provider business mailing address

154 WATERMAN AVE
PROVIDENCE RI
02911-1030
US

V. Phone/Fax

Practice location:
  • Phone: 401-453-0666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM J MOROCCO
Title or Position: OWNER
Credential: MD
Phone: 508-801-7817