MEDICARE: PETER F DEBLASIO JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	RI5407	RI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	180000314	OTHER	RI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174514210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER F DEBLASIO JR. MD

Provider Business Mailing Address
First Line	:	1532 SMITH ST
Second Line	:
City	:	NORTH PROVIDENCE
State	:	RI
Zip	:	02911-2939
Country	:	US
Telephone Number	:	401-353-5735
Fax Number	:	401-353-1020

Provider Business Practice Location Address
First Line	:	1532 SMITH ST
Second Line	:
City	:	NORTH PROVIDENCE
State	:	RI
Zip	:	02911-2939
Country	:	US
Telephone Number	:	401-353-5735
Fax Number	:	401-353-1020

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2005
Last Update Date	:	02/10/2025

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