1720202716 NPI number — ROGER J FERLAND, M.D., P.C.

Table of content: (NPI 1720202716)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720202716 NPI number — ROGER J FERLAND, M.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROGER J FERLAND, M.D., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GYN SPECIALIST
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720202716
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
695 EDDY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02903-4941
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-331-0669
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
695 EDDY ST
Provider Second Line Business Practice Location Address:
22
Provider Business Practice Location Address City Name:
PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02903-4941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-331-0669
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/12/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
SANDY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
401-331-0669

Provider Taxonomy Codes

  • Taxonomy code: 207VH0002X , with the licence number:  RI6030 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02345-6 . This is a "BLUE CROSS RHODE ISLAND" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 662292 . This is a "TUFTS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9004039 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0899 . This is a "NEIGHBORHOOD HEALTH" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 13883 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".