Healthcare Provider Details

I. General information

NPI: 1649206277
Provider Name (Legal Business Name): BALD HILL PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 BALD HILL RD SUITE 501
WARWICK RI
02886-1617
US

IV. Provider business mailing address

400 BALD HILL RD SUITE 501
WARWICK RI
02886-1617
US

V. Phone/Fax

Practice location:
  • Phone: 401-732-5437
  • Fax: 401-732-5095
Mailing address:
  • Phone: 401-732-5437
  • Fax: 401-732-5095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARILYN BOICHAT
Title or Position: PRACTICE MANAGER
Credential:
Phone: 401-732-5437