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General NPI Number Information
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NPI Number | 1073864591
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Entity Type | Organization
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Legal Business Name | PEDIATRIC ENDOCRINOLOGY OF RHODE ISLAND
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Dates
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Enumeration Date | 09/24/2012
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Last Update Date | 04/01/2014
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Provider Practice Location Address
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Address Line | 105 SOCKANOSSET CROSS ROAD SUITE 318
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City | CRANSTON
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State | RI
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Zip | 02920
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Country | US
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Telephone | 401-434-2058
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Fax | 401-633-6854
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Provider Business Mailing Address
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Address Line | 50 AMARAL ST
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City | EAST PROVIDENCE
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State | RI
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Zip | 02915-2205
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Country | US
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Telephone | 401-434-2058
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Fax | 401-633-6854
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Authorized Official
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Title or Position | SOLE OWNER/ MEDICAL DIRECTOR
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Name | REBECCA MCEACHERN
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Credential | MD
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Telephone | 401-419-8091
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0205X
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Taxonomy Name | Pediatric Endocrinology Physician
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License Number | 11312
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License Number State | RI
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