=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174738967
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | COLETTE S. VIEAU M. D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2007
-----------------------------------------------------
Last Update Date | 06/14/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 95 PITMAN ST STE 2200
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02906-4311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-437-6777
-----------------------------------------------------
Fax | 401-437-6814
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 58 BLUFF AVE
-----------------------------------------------------
City | CRANSTON
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02905-5106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-662-1604
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | MD13049
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------