MEDICARE: MR. SIAVASH GHOREISHI 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	208000000X	Pediatrics Physician	MD06842	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	201159	OTHER	BLUE CHIP
2	2684	OTHER	BC
3	406185	OTHER	TUTTS
4	1200203	OTHER	UHC
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508964636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SIAVASH GHOREISHI MD

Provider Business Mailing Address
First Line	:	5835 POST ROAD
Second Line	:	PLAZA 2 SUITE 110
City	:	EAST GREENWICH
State	:	RI
Zip	:	02818-2154
Country	:	US
Telephone Number	:	401-885-3390
Fax Number	:	401-885-8713

Provider Business Practice Location Address
First Line	:	5835 POST ROAD
Second Line	:	PLAZA 2 SUITE 110
City	:	EAST GREENWICH
State	:	RI
Zip	:	02818-2154
Country	:	US
Telephone Number	:	401-885-3390
Fax Number	:	401-885-8713

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	05/08/2013

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