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NPI Code Detail

MEDICARE: ERIC B RADLER M.D.

MEDICARE: ERIC B RADLER M.D.
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
1207R00000XInternal Medicine PhysicianMD11047RI
2208M00000XHospitalist PhysicianMD11047RI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
129883-4OTHERRIBC/BS
2410069OTHERRIBLUECHIP
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1942290010
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIC B RADLER M.D.
Provider Business Mailing Address
First Line : 117 ELLENFIELD ST
Second Line : SUITE 101
City : PROVIDENCE
State : RI
Zip : 02905-4513
Country : US
Telephone Number : 401-444-6779
Fax Number : 401-444-6912
Provider Business Practice Location Address
First Line : 11 FRIENDSHIP ST
Second Line :
City : NEWPORT
State : RI
Zip : 02840-2271
Country : US
Telephone Number : 401-846-6400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2005
Last Update Date : 04/21/2015

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