=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184942930
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRIMARY CARE OF BARRINGTON LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2010
-----------------------------------------------------
Last Update Date | 05/04/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 60 BAY SPRING AVE UNIT A1
-----------------------------------------------------
City | BARRINGTON
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02806-1384
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-289-2961
-----------------------------------------------------
Fax | 401-289-2963
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 60 BAY SPRING AVE UNIT A1
-----------------------------------------------------
City | BARRINGTON
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02806-1384
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-289-2961
-----------------------------------------------------
Fax | 401-289-2963
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. GREGORY SADOVNIKOFF
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 401-289-2961
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD10134
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------