1770689002 NPI number — CHAD P. NEVOLA, MD, INC.

Table of content: (NPI 1770689002)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770689002 NPI number — CHAD P. NEVOLA, MD, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHAD P. NEVOLA, MD, INC.
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:
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:
1770689002
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 DUDLEY ST
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02905-2436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-273-9555
Provider Business Mailing Address Fax Number:
401-861-4943

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 DUDLEY ST
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02905-2436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-273-9555
Provider Business Practice Location Address Fax Number:
401-861-4943
Provider Enumeration Date:
09/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NEVOLA
Authorized Official First Name:
CHAD
Authorized Official Middle Name:
PETER
Authorized Official Title or Position:
SOLE STOCKHOLDER
Authorized Official Telephone Number:
401-273-9555

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  MD10281 , 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: 2642815 . This is a "FIRST HEALTH OF RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 407860 . This is a "HCVM OF RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 31505-8 . This is a "BLUE CROSS/BLUE SHIELD RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 710058301 . This is a "CIGNA" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: CN32566 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1984965 . This is a "UNITED HEALTH PLAN OF RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 3815 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 407401 . This is a "BLUE CHIP OF RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 478834 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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