Healthcare Provider Details

I. General information

NPI: 1558403550
Provider Name (Legal Business Name): NARRAGANSETT BAY PEDIATRICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 KENYON AVE SUITE 101
WAKEFIELD RI
02879-4239
US

IV. Provider business mailing address

70 KENYON AVE SUITE 101
WAKEFIELD RI
02879-4239
US

V. Phone/Fax

Practice location:
  • Phone: 401-789-5924
  • Fax: 401-782-1770
Mailing address:
  • Phone: 401-789-5924
  • Fax: 401-782-1770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. CELESTE C. CORCORAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 401-789-5924