=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982758207
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PETER J BELLAFIORE MD, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 70 KENYON AVE SUITE 321
-----------------------------------------------------
City | WAKEFIELD
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02879-4239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-789-4885
-----------------------------------------------------
Fax | 401-792-0201
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 70 KENYON AVE SUITE 321
-----------------------------------------------------
City | WAKEFIELD
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02879-4239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-789-4885
-----------------------------------------------------
Fax | 401-792-0201
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PETER J BELLAFIORE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 401-789-4885
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | MD8924
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------