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General NPI Number Information
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NPI Number | 1912030792
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Entity Type | Organization
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Legal Business Name | KINGSTOWN PEDIATRICS INC
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 06/21/2013
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Provider Practice Location Address
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Address Line | 420 SCRABBLETOWN RD STE A
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City | NORTH KINGSTOWN
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State | RI
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Zip | 02852-3638
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Country | US
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Telephone | 401-295-7400
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Fax | 401-295-7825
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Provider Business Mailing Address
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Address Line | 420 SCRABBLETOWN RD STE A
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City | NORTH KINGSTOWN
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State | RI
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Zip | 02852-3638
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Country | US
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Telephone | 401-295-7400
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Fax | 401-295-7825
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Authorized Official
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Title or Position | OWNER
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Name | COLLEEN ANN POWERS
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Credential | MD
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Telephone | 401-295-7400
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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 | RI09449
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License Number State | RI
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