MEDICARE: CRANSTON PEDIATRICS LLC DBA PARK PEDIATRICS 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	208000000X	Pediatrics Physician	MD11641	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	412877	OTHER	RI	HEALTHMATE
2	MD 11641	OTHER	RI	LICENSE NUMBER
3	30943	OTHER	RI	NEIGHBORHOOD HEALTH PLAN
4	31923-4	OTHER	RI	BLUE CROSS BLUE SHIELD
5	25-79403	OTHER	RI	UNITED HEALTH PLAN
6	412877	OTHER	RI	BLUE CHIP
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669690418
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRANSTON PEDIATRICS LLC DBA PARK PEDIATRICS INC

Provider Business Mailing Address
First Line	:	801 PARK AVE
Second Line	:
City	:	CRANSTON
State	:	RI
Zip	:	02910-2036
Country	:	US
Telephone Number	:	401-274-6575
Fax Number	:	401-273-2597

Provider Business Practice Location Address
First Line	:	801 PARK AVE
Second Line	:
City	:	CRANSTON
State	:	RI
Zip	:	02910-2036
Country	:	US
Telephone Number	:	401-274-6575
Fax Number	:	401-273-2597

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RICK MANUEL QUILES
Credential	:	M.D.
Telephone Number	:	401-274-6575

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	04/22/2008

Similar Medicare Providers

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Practice Location Address:

801 PARK AVE
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02910-2036

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Practice Location Address:

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1861834012 — ARTISTRY DENTAL
Practice Location Address:

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1184222077 — DR. HYUN JIN CHUNG PHD
Practice Location Address:

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Directions to “CRANSTON PEDIATRICS LLC DBA PARK PEDIATRICS INC ” Practice Location

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