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General NPI Number Information
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NPI Number | 1093991945
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Entity Type | Organization
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Legal Business Name | ROBERT B TRIVETT
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Dates
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Enumeration Date | 01/10/2008
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Last Update Date | 01/10/2008
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Provider Practice Location Address
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Address Line | 35 WEAVER RD
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City | NORTH KINGSTOWN
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State | RI
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Zip | 02852-7135
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Country | US
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Telephone | 401-295-9719
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Fax | 401-295-0150
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Provider Business Mailing Address
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Address Line | 35 WEAVER RD
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City | NORTH KINGSTOWN
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State | RI
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Zip | 02852-7135
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Country | US
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Telephone | 401-295-9719
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Fax | 401-295-0150
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Authorized Official
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Title or Position | SOLE PROPRIETIER
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Name | DR. ROBERT BOWEN TRIVETT
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Credential | MD
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Telephone | 401-295-9719
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0000X
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Taxonomy Name | Adolescent Medicine (Family Medicine) Physician
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License Number | RI4853
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License Number State | RI
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