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General NPI Number Information
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NPI Number | 1003982547
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Entity Type | Organization
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Legal Business Name | HERITAGE MEDICAL ASSOCIATES PC
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 10/13/2015
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Provider Practice Location Address
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Address Line | 131 BEECHWOOD AVE
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City | PAWTUCKET
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State | RI
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Zip | 02860-5409
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Country | US
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Telephone | 401-475-1999
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Fax | 401-475-6932
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Provider Business Mailing Address
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Address Line | 131 BEECHWOOD AVE
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City | PAWTUCKET
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State | RI
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Zip | 02860-5409
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Country | US
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Telephone | 401-475-1999
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Fax | 401-475-6932
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN PETER MISKOVSKY
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Credential | MD
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Telephone | 401-475-1999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | CT 0816
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD 10350
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License Number State | RI
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