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General NPI Number Information
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NPI Number | 1770689002
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Entity Type | Organization
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Legal Business Name | CHAD P. NEVOLA, MD, INC.
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 06/12/2008
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Provider Practice Location Address
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Address Line | 120 DUDLEY ST SUITE 105
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City | PROVIDENCE
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State | RI
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Zip | 02905-2436
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Country | US
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Telephone | 401-273-9555
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Fax | 401-861-4943
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Provider Business Mailing Address
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Address Line | 120 DUDLEY ST SUITE 105
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City | PROVIDENCE
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State | RI
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Zip | 02905-2436
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Country | US
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Telephone | 401-273-9555
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Fax | 401-861-4943
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Authorized Official
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Title or Position | SOLE STOCKHOLDER
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Name | CHAD PETER NEVOLA
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Credential | MD
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Telephone | 401-273-9555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD10281
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License Number State | RI
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