MEDICARE: EAST COAST PRIMARY CARE, INC.

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	207R00000X	Internal Medicine Physician

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	:	1619954104
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST COAST PRIMARY CARE, INC.

Provider Business Mailing Address
First Line	:	63 EDDIE DOWLING HWY
Second Line	:	SUITE 3
City	:	NORTH SMITHFIELD
State	:	RI
Zip	:	02896-7322
Country	:	US
Telephone Number	:	401-766-8200
Fax Number	:

Provider Business Practice Location Address
First Line	:	63 EDDIE DOWLING HWY
Second Line	:	SUITE 3
City	:	NORTH SMITHFIELD
State	:	RI
Zip	:	02896-7322
Country	:	US
Telephone Number	:	401-766-8200
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AFSHIN NASSERI
Credential	:	MD
Telephone Number	:	401-766-8200

Provider Enumeration Date	:	12/27/2005
Last Update Date	:	08/22/2020

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