1669768818 NPI number — ELISA SEMEDO DPT

Table of content: ELISA SEMEDO DPT (NPI 1669768818)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669768818 NPI number — ELISA SEMEDO DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEMEDO
Provider First Name:
ELISA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
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:
1669768818
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 RICHMOND SQ STE 200
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:
02906-5117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-433-4172
Provider Business Mailing Address Fax Number:
401-433-0612

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21 DIVISION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAWTUCKET
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02860-5352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-726-7100
Provider Business Practice Location Address Fax Number:
401-721-5214
Provider Enumeration Date:
06/27/2011

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:  1311010 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: PT02428 , 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: PENDING . This is a "MEDICARE PENDING" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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