Healthcare Provider Details

I. General information

NPI: 1871623462
Provider Name (Legal Business Name): DAVID PAIK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 CASS AVENUE
WOONSOCKET RI
02895
US

IV. Provider business mailing address

42 HEMINGWAY DR
RIVERSIDE RI
02915
US

V. Phone/Fax

Practice location:
  • Phone: 401-769-4100
  • Fax:
Mailing address:
  • Phone: 401-490-2130
  • Fax: 401-490-2141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD04278
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: