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General NPI Number Information
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NPI Number | 1992825293
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Entity Type | Organization
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Legal Business Name | NORTHPROVIDENCEPEDIATRICS
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 08/30/2013
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Provider Practice Location Address
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Address Line | 1169 MINERAL SPRING AVE
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City | NORTH PROVIDENCE
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State | RI
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Zip | 02904-4102
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Country | US
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Telephone | 401-725-3888
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Fax | 401-725-3188
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Provider Business Mailing Address
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Address Line | 1169 MINERAL SPRING AVE
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City | NORTH PROVIDENCE
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State | RI
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Zip | 02904-4102
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Country | US
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Telephone | 401-725-3888
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Fax | 401-725-3188
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. DOREEN MICHELLE CIANCAGLINI
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Credential | M.D.
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Telephone | 401-725-3888
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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 |
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License Number State |
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