1104854595 NPI number — MRS. CHRISTINE M VOLLUCCI MS PT

Table of content: MRS. CHRISTINE M VOLLUCCI MS PT (NPI 1104854595)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104854595 NPI number — MRS. CHRISTINE M VOLLUCCI MS PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VOLLUCCI
Provider First Name:
CHRISTINE
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1104854595
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
37 ARCADIA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH KINGSTOWN
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02852-4601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-398-9447
Provider Business Mailing Address Fax Number:
401-463-5808

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
140 POINT JUDITH RD
Provider Second Line Business Practice Location Address:
SUITE 47
Provider Business Practice Location Address City Name:
NARRAGANSETT
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02882-3477
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-789-2077
Provider Business Practice Location Address Fax Number:
401-782-4762
Provider Enumeration Date:
06/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT01502 , 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: 406099 . This is a "BLUE CHIP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 290155 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".




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