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General NPI Number Information
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NPI Number | 1003239286
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Entity Type | Organization
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Legal Business Name | KEVIN E. BAILL MD & ASSOCIATES, LLC
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Dates
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Enumeration Date | 01/24/2014
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Last Update Date | 01/24/2014
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Provider Practice Location Address
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Address Line | 345 BLACKSTONE BLVD
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City | PROVIDENCE
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State | RI
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Zip | 02906-4800
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Country | US
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Telephone | 917-447-2138
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Fax |
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Provider Business Mailing Address
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Address Line | 345 BLACKSTONE BLVD
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City | PROVIDENCE
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State | RI
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Zip | 02906-4800
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Country | US
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Telephone | 917-447-2138
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEVIN ELLIOT BAILL
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Credential | MD
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Telephone | 917-447-2138
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 12179
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License Number State | RI
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