| Coastal Medical | |
|
593 Eddy St Providence RI 02903-4923 | |
| (401) 444-6779 | |
| (401) 444-6912 |
| Full Name | Coastal Medical |
|---|---|
| Speciality | Internal Medicine |
| Location | 593 Eddy St, Providence, Rhode Island |
| Authorized Official Name and Position | Peter K Markell (EVP & CFO) |
| Authorized Official Contact | 4014447914 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastal Medical 117 Ellenfield St Ste 101 Providence RI 02905-4541 Ph: (401) 444-6779 | Coastal Medical 593 Eddy St Providence RI 02903-4923 Ph: (401) 444-6779 |
| NPI Number | 1780273540 |
|---|---|
| Provider Enumeration Date | 01/15/2021 |
| Last Update Date | 05/09/2024 |
| Certification Date | 11/17/2023 |
| Medicare PECOS PAC ID | 0345658316 |
|---|---|
| Medicare Enrollment ID | O20210427001413 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780273540 | NPI | - | NPPES |
| Provider Name | David L Fried |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1275520678 PECOS PAC ID: 4082519772 Enrollment ID: I20031205000022 |
| Provider Name | Daniel K Asiedu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1932164589 PECOS PAC ID: 6901799451 Enrollment ID: I20040206000688 |
| Provider Name | Eileen M Gonzalez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134278369 PECOS PAC ID: 7810883634 Enrollment ID: I20040226000955 |
| Provider Name | Matthew T Salisbury |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1477511236 PECOS PAC ID: 2062302821 Enrollment ID: I20040317000219 |
| Provider Name | Francis M Sullivan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1649286774 PECOS PAC ID: 7012807126 Enrollment ID: I20040319000953 |
| Provider Name | Robert O Cicchelli |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508851601 PECOS PAC ID: 5991792483 Enrollment ID: I20040427001202 |
| Provider Name | Rinchen-tz Emgushov |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1760477962 PECOS PAC ID: 6103815147 Enrollment ID: I20040506001049 |
| Provider Name | Jeffry C Winters |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1992790018 PECOS PAC ID: 2567451370 Enrollment ID: I20040507000684 |
| Provider Name | Ronald M Gilman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1346237039 PECOS PAC ID: 0941282990 Enrollment ID: I20040603000307 |
| Provider Name | James R Myers |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578550265 PECOS PAC ID: 3870575442 Enrollment ID: I20040607000745 |
| Provider Name | Iris L Tong |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1033150586 PECOS PAC ID: 2567446966 Enrollment ID: I20040615000051 |
| Provider Name | Sheenagh M Bodkin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548205735 PECOS PAC ID: 3173507597 Enrollment ID: I20040615000224 |
| Provider Name | Shelly L Johnson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528055191 PECOS PAC ID: 4183600406 Enrollment ID: I20040628000640 |
| Provider Name | Dariusz Kostrzewa |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154317600 PECOS PAC ID: 4082693437 Enrollment ID: I20040719000549 |
| Provider Name | Karen H Stevenson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1609861723 PECOS PAC ID: 2567434202 Enrollment ID: I20040812000006 |
| Provider Name | Carole Lengyel |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1568441699 PECOS PAC ID: 2163499740 Enrollment ID: I20040914000010 |
| Provider Name | Larry J Schoenfeld |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1245227768 PECOS PAC ID: 2466414750 Enrollment ID: I20041029000078 |
| Provider Name | Tesfaye Meren |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1336136852 PECOS PAC ID: 1456313741 Enrollment ID: I20041029000085 |
| Provider Name | Audrey R Kupchan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1609863125 PECOS PAC ID: 8628030913 Enrollment ID: I20041029000092 |
| Provider Name | Yul D Ejnes |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1679568802 PECOS PAC ID: 4981666278 Enrollment ID: I20041029000099 |
| Provider Name | William A Levin |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1669470886 PECOS PAC ID: 5597723007 Enrollment ID: I20041230000358 |
| Provider Name | Parul D Shah |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972560258 PECOS PAC ID: 8729037536 Enrollment ID: I20050119000769 |
| Provider Name | Pamela I Lauria |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528055233 PECOS PAC ID: 3375595895 Enrollment ID: I20050214000113 |
| Provider Name | Michael J B Gonzalez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265433908 PECOS PAC ID: 5799737847 Enrollment ID: I20050216000801 |
| Provider Name | Edward Mcgookin |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1427045905 PECOS PAC ID: 4688627334 Enrollment ID: I20050223000135 |
| Provider Name | John A Gaines |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1568457224 PECOS PAC ID: 2264479823 Enrollment ID: I20050414000762 |
| Provider Name | John Finigan |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1912994443 PECOS PAC ID: 6305884636 Enrollment ID: I20050418001376 |
| Provider Name | Elizabeth Lange |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1518954098 PECOS PAC ID: 5698713329 Enrollment ID: I20050421001451 |
| Provider Name | Barbara Gaines |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1366439895 PECOS PAC ID: 9436197027 Enrollment ID: I20050423000104 |
| Provider Name | David Gary Kerzer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487641411 PECOS PAC ID: 4284672734 Enrollment ID: I20050425000536 |
| Provider Name | Joseph S Terlato |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1770577298 PECOS PAC ID: 9133165905 Enrollment ID: I20050701000171 |
| Provider Name | Michael A Pomerantz |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1437146131 PECOS PAC ID: 6002842168 Enrollment ID: I20050711000704 |
| Provider Name | Suzanne Burns |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1144217829 PECOS PAC ID: 1456388651 Enrollment ID: I20050719001247 |
| Provider Name | Rajnish Bansal |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1417944190 PECOS PAC ID: 7416984612 Enrollment ID: I20050719001286 |
| Provider Name | David E Leibowitz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1477570018 PECOS PAC ID: 9335178789 Enrollment ID: I20050806000189 |
| Provider Name | Anne E Neuville |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588661722 PECOS PAC ID: 2163452053 Enrollment ID: I20050819000820 |
| Provider Name | Mary E Sette |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801836267 PECOS PAC ID: 5890728976 Enrollment ID: I20050919000416 |
| Provider Name | Anthony J Alario |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1386697357 PECOS PAC ID: 9830116789 Enrollment ID: I20051029000267 |
| Provider Name | Kathy A Rebeiro |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073539813 PECOS PAC ID: 0143249144 Enrollment ID: I20051118000642 |
| Provider Name | Amy Goldfarb |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1629063847 PECOS PAC ID: 4284653288 Enrollment ID: I20051118000683 |
| Provider Name | Alice R Zory |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366469124 PECOS PAC ID: 8921020603 Enrollment ID: I20051221000951 |
| Provider Name | Joyce Alves |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205811635 PECOS PAC ID: 3870502040 Enrollment ID: I20060417000420 |
| Provider Name | Luis A Osorio |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1427042860 PECOS PAC ID: 2062419740 Enrollment ID: I20061024000038 |
| Provider Name | Nicole P Somvanshi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417926890 PECOS PAC ID: 8325096332 Enrollment ID: I20070103000140 |
| Provider Name | Marjorie S Carges |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1356321483 PECOS PAC ID: 5092813808 Enrollment ID: I20071113000809 |
| Provider Name | Cynthia Bliss |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1710999552 PECOS PAC ID: 9234202318 Enrollment ID: I20080723000179 |
| Provider Name | Bethany Ann Erickson-caron |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487805271 PECOS PAC ID: 7416018551 Enrollment ID: I20081208000091 |
| Provider Name | Anne E Cushing-brescia |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1407839657 PECOS PAC ID: 6507813326 Enrollment ID: I20090622000486 |
| Provider Name | Ma Liza Ann Famador |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760676548 PECOS PAC ID: 0648316935 Enrollment ID: I20090929000573 |
| Provider Name | Anne Camille A Montes |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679767453 PECOS PAC ID: 6608912928 Enrollment ID: I20090930000095 |
| Provider Name | Nicole M Gardella |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639313810 PECOS PAC ID: 0143366138 Enrollment ID: I20091005000699 |
| Provider Name | Priya Bansal |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1992811871 PECOS PAC ID: 8123168333 Enrollment ID: I20091221000029 |
| Provider Name | Judith G Shaw |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1467449959 PECOS PAC ID: 0244278067 Enrollment ID: I20100609000740 |
| Provider Name | Vanessa R Greenier |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356337745 PECOS PAC ID: 2466401310 Enrollment ID: I20100728000993 |
| Provider Name | Barbara W Jablow |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306934369 PECOS PAC ID: 3870627839 Enrollment ID: I20100813000122 |
| Provider Name | Kathryn O Coolidge |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1649472895 PECOS PAC ID: 4688708399 Enrollment ID: I20100817001012 |
| Provider Name | Christine Kennedy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285722231 PECOS PAC ID: 9436274396 Enrollment ID: I20100915000629 |
| Provider Name | Cristina Mitchell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407943814 PECOS PAC ID: 3173648789 Enrollment ID: I20100918000214 |
| Provider Name | Faridah Tanya B Rodriguez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902050503 PECOS PAC ID: 9931225448 Enrollment ID: I20100921001511 |
| Provider Name | Manoj Garg |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285610600 PECOS PAC ID: 8123062643 Enrollment ID: I20101008000751 |
| Provider Name | Joseph T Zibrida |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356379242 PECOS PAC ID: 4082739313 Enrollment ID: I20101108001228 |
| Provider Name | Frank Amalfitano |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1427087576 PECOS PAC ID: 2264557594 Enrollment ID: I20101110001467 |
| Provider Name | John Fx Horan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679567531 PECOS PAC ID: 1557499316 Enrollment ID: I20101222000223 |
| Provider Name | Karen R Smigel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114905528 PECOS PAC ID: 9638119142 Enrollment ID: I20110303000888 |
| Provider Name | Joy Ziegler |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1467498345 PECOS PAC ID: 6406030410 Enrollment ID: I20110414000765 |
| Provider Name | Barbara Coghlin |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1023054905 PECOS PAC ID: 4385828391 Enrollment ID: I20110414000801 |
| Provider Name | Mary E Murray |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1013943240 PECOS PAC ID: 4284818220 Enrollment ID: I20110415000117 |
| Provider Name | Robert Maltz |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1033146931 PECOS PAC ID: 7719161637 Enrollment ID: I20110418000333 |
| Provider Name | Kenneth F Sperber |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154382562 PECOS PAC ID: 5395808133 Enrollment ID: I20110518000353 |
| Provider Name | Tanya K Solberg |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1063422673 PECOS PAC ID: 4183802424 Enrollment ID: I20110711000040 |
| Provider Name | Mridula Menon |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1427045301 PECOS PAC ID: 6406817261 Enrollment ID: I20110805000052 |
| Provider Name | Carla M Vaccaro |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285613448 PECOS PAC ID: 2062575558 Enrollment ID: I20110810000335 |
| Provider Name | Laura E Tavares |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144500356 PECOS PAC ID: 0840462297 Enrollment ID: I20111007000542 |
| Provider Name | Donald R Murphy |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1265440218 PECOS PAC ID: 9537112156 Enrollment ID: I20120112000429 |
| Provider Name | Deqiang Zhang |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831327642 PECOS PAC ID: 9234388323 Enrollment ID: I20121004000768 |
| Provider Name | William J Slade |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730414640 PECOS PAC ID: 2961651096 Enrollment ID: I20121005000249 |
| Provider Name | Kathleen Marie Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407193535 PECOS PAC ID: 9436395274 Enrollment ID: I20130423000204 |
| Provider Name | Stephanie Tuttle Maryeski |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528118031 PECOS PAC ID: 9931386877 Enrollment ID: I20130716000180 |
| Provider Name | Jeffrey D Manning |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1932212081 PECOS PAC ID: 1658563655 Enrollment ID: I20130918000010 |
| Provider Name | Lauren S Ward |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982924890 PECOS PAC ID: 7618111246 Enrollment ID: I20130920000021 |
| Provider Name | Laura H Dawson |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1578857611 PECOS PAC ID: 8729205422 Enrollment ID: I20140804000394 |
| Provider Name | Jessica L Mullins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942616719 PECOS PAC ID: 4082834957 Enrollment ID: I20140929001365 |
| Provider Name | Sara A Petit |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285044305 PECOS PAC ID: 4789804352 Enrollment ID: I20141002000281 |
| Provider Name | Kimberly A Propert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720347123 PECOS PAC ID: 0345470332 Enrollment ID: I20141105000027 |
| Provider Name | Martha R Leonard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417123902 PECOS PAC ID: 7214188671 Enrollment ID: I20141125000323 |
| Provider Name | Lola Mclaren Cevallos |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518298272 PECOS PAC ID: 2860664752 Enrollment ID: I20141210002231 |
| Provider Name | Romi A Webster |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1922046218 PECOS PAC ID: 0941499172 Enrollment ID: I20141217000197 |
| Provider Name | Raymond P Zarlengo |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1003916875 PECOS PAC ID: 3375868243 Enrollment ID: I20150217001913 |
| Provider Name | Roger N Mennillo |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1730155482 PECOS PAC ID: 6406171396 Enrollment ID: I20150218000265 |
| Provider Name | David J. Hunt |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1316083330 PECOS PAC ID: 4587989298 Enrollment ID: I20150220000547 |
| Provider Name | Meridith Malysz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205225273 PECOS PAC ID: 3870811425 Enrollment ID: I20150413000544 |
| Provider Name | Laura Ann Beaudry |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235563842 PECOS PAC ID: 4284954181 Enrollment ID: I20150515001713 |
| Provider Name | Mariah H Stump |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1841550738 PECOS PAC ID: 3476770991 Enrollment ID: I20150630000199 |
| Provider Name | Kristen B Hubbard |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1033471206 PECOS PAC ID: 1355661737 Enrollment ID: I20150702000351 |
| Provider Name | Jana Magarian |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649662107 PECOS PAC ID: 9133432487 Enrollment ID: I20150716000716 |
| Provider Name | Caasi P Baima |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629456371 PECOS PAC ID: 1456665876 Enrollment ID: I20150729009534 |
| Provider Name | Michelle K Woolfrey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922486554 PECOS PAC ID: 9234443276 Enrollment ID: I20150804004393 |
| Provider Name | Alexandra Sophocles Ruggiero |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982907879 PECOS PAC ID: 9830408962 Enrollment ID: I20160829003314 |
| Provider Name | Antoinette O Sullivan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366582819 PECOS PAC ID: 8921386814 Enrollment ID: I20161027001305 |
| Provider Name | David E Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962958157 PECOS PAC ID: 5496035958 Enrollment ID: I20161129002768 |
| Provider Name | Joanna J Schatz |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1386964112 PECOS PAC ID: 0547542466 Enrollment ID: I20170127002213 |
| Provider Name | Bettina W Killion |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750305330 PECOS PAC ID: 8729092473 Enrollment ID: I20170308000243 |
| Provider Name | Jing Tang |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1184044836 PECOS PAC ID: 7810274412 Enrollment ID: I20170509001753 |
| Provider Name | Jillian D Henry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760916357 PECOS PAC ID: 9133496052 Enrollment ID: I20170525000459 |
| Provider Name | Jena Mcclure Richter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164972139 PECOS PAC ID: 8527348333 Enrollment ID: I20170607001182 |
| Provider Name | Christopher E Storey |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972913028 PECOS PAC ID: 6608195623 Enrollment ID: I20170616000664 |
| Provider Name | Agnieszka M Kendall |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1104837780 PECOS PAC ID: 6103194956 Enrollment ID: I20170620000671 |
| Provider Name | Jeffrey Cumplido |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1881008480 PECOS PAC ID: 5991922262 Enrollment ID: I20170622002727 |
| Provider Name | Lily M Pike |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467719088 PECOS PAC ID: 6800102054 Enrollment ID: I20170630001325 |
| Provider Name | Jason B Kerzer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497165880 PECOS PAC ID: 2365747334 Enrollment ID: I20170810000674 |
| Provider Name | Jill Welte |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1902957913 PECOS PAC ID: 7618904772 Enrollment ID: I20170816003758 |
| Provider Name | Nancy Lasson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1679572390 PECOS PAC ID: 6103993456 Enrollment ID: I20170824000832 |
| Provider Name | Ryan D Rossi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578909289 PECOS PAC ID: 7012280373 Enrollment ID: I20170907002713 |
| Provider Name | Chien-hsiang Weng |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922412881 PECOS PAC ID: 6103045729 Enrollment ID: I20171020001855 |
| Provider Name | Penny Mclean-nowinski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013238351 PECOS PAC ID: 5698809812 Enrollment ID: I20171113000188 |
| Provider Name | Cynthia M Lover |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669583795 PECOS PAC ID: 5193086023 Enrollment ID: I20180309000916 |
| Provider Name | Myra A Chaudary |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821478124 PECOS PAC ID: 2769798040 Enrollment ID: I20180806001036 |
| Provider Name | Christina Bortz |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972997138 PECOS PAC ID: 0446508295 Enrollment ID: I20180809006201 |
| Provider Name | Katherine Lowe Weingartner |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1730366782 PECOS PAC ID: 1254685191 Enrollment ID: I20181113002303 |
| Provider Name | Chrystal Vergara-lopez |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1932676806 PECOS PAC ID: 9133465826 Enrollment ID: I20190117001181 |
| Provider Name | Andrea M Burdon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871051029 PECOS PAC ID: 0042551350 Enrollment ID: I20190416000110 |
| Provider Name | Lauren Nicole Waterman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295298677 PECOS PAC ID: 8224371430 Enrollment ID: I20190509002157 |
| Provider Name | Meghan Labossiere |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558823013 PECOS PAC ID: 4183967300 Enrollment ID: I20190509002461 |
| Provider Name | Liza S Cantor |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1992152219 PECOS PAC ID: 5496040669 Enrollment ID: I20190627001507 |
| Provider Name | Jennifer Allen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104450881 PECOS PAC ID: 2365873460 Enrollment ID: I20200505001075 |
| Provider Name | Von Marie Rodriguez-guzman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1831505163 PECOS PAC ID: 2668895707 Enrollment ID: I20200708003098 |
| Provider Name | Yvette Oliveira |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336509413 PECOS PAC ID: 0840614947 Enrollment ID: I20200722002043 |
| Provider Name | Kelly Fitzgerald Cohen |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1629509112 PECOS PAC ID: 3870919533 Enrollment ID: I20200812003056 |
| Provider Name | Despoina Mavrommati |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1659892289 PECOS PAC ID: 8527484849 Enrollment ID: I20200818001550 |
| Provider Name | Melvin Madampil Philip |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1730530791 PECOS PAC ID: 2264859941 Enrollment ID: I20200826000990 |
| Provider Name | Heather Lillibridge |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447878327 PECOS PAC ID: 1052738093 Enrollment ID: I20200904001064 |
| Provider Name | Maureen M. Baur |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1225303548 PECOS PAC ID: 4284861725 Enrollment ID: I20200910003316 |
| Provider Name | Kenneth Wells |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629097506 PECOS PAC ID: 9739402702 Enrollment ID: I20201106001718 |
| Provider Name | William Muse |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1518321165 PECOS PAC ID: 4183919228 Enrollment ID: I20201119002775 |
| Provider Name | Kristin Evelyn Macdonald |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245872787 PECOS PAC ID: 0547671604 Enrollment ID: I20201120000382 |
| Provider Name | Sevil Hemayat |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063868297 PECOS PAC ID: 8628480084 Enrollment ID: I20201209002385 |
| Provider Name | Aaron Scheinman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1801240999 PECOS PAC ID: 7012326846 Enrollment ID: I20210507001698 |
| Provider Name | Prateek Bhattacharya |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1164927760 PECOS PAC ID: 7113336892 Enrollment ID: I20210510001499 |
| Provider Name | Fernando Calero Baquerizo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1407197395 PECOS PAC ID: 3476867227 Enrollment ID: I20210510002777 |
| Provider Name | Nkenna Odom |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972098465 PECOS PAC ID: 1153723119 Enrollment ID: I20210713002742 |
| Provider Name | Huiling Ji |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1962998468 PECOS PAC ID: 3375975873 Enrollment ID: I20210727002153 |
| Provider Name | Paul R Larson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952547424 PECOS PAC ID: 3971584046 Enrollment ID: I20210805002931 |
| Provider Name | Laura Grace Ward |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1841553724 PECOS PAC ID: 6002210135 Enrollment ID: I20210811001268 |
| Provider Name | Laura Fishpaw |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790339885 PECOS PAC ID: 9638574197 Enrollment ID: I20210820001490 |
| Provider Name | Archen Krupadev |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1336630458 PECOS PAC ID: 9133525272 Enrollment ID: I20210915000671 |
| Provider Name | Keryann Estrela |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396336475 PECOS PAC ID: 0446657365 Enrollment ID: I20210920003245 |
| Provider Name | Victoria Elena Marques |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1316527468 PECOS PAC ID: 8224436480 Enrollment ID: I20211001002886 |
| Provider Name | Meagan Coon |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1831729227 PECOS PAC ID: 8224459060 Enrollment ID: I20211110000164 |
| Provider Name | Angelina Papaioannou |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215544606 PECOS PAC ID: 9537559794 Enrollment ID: I20211201002025 |
| Provider Name | Eucharia U Ibeh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194326991 PECOS PAC ID: 6103236229 Enrollment ID: I20211223001509 |
| Provider Name | James Anthony Mastrostefano |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083384036 PECOS PAC ID: 3577954502 Enrollment ID: I20211229001069 |
| Provider Name | Karin Camara |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528526415 PECOS PAC ID: 3678987823 Enrollment ID: I20220208002393 |
| Provider Name | Cayla Richardson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740943281 PECOS PAC ID: 3375936446 Enrollment ID: I20220214000686 |
| Provider Name | Kayla Reall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912665100 PECOS PAC ID: 3072906148 Enrollment ID: I20220214000836 |
| Provider Name | Kathleen Patricia Natareno |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073110714 PECOS PAC ID: 3577957257 Enrollment ID: I20220222002485 |
| Provider Name | Pierre A Caron |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871588947 PECOS PAC ID: 5294870069 Enrollment ID: I20220314000835 |
| Provider Name | Katie Gervasini |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952054496 PECOS PAC ID: 1759777550 Enrollment ID: I20220404001742 |
| Provider Name | Melissa Afonso Duarte Santos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417615378 PECOS PAC ID: 5193111995 Enrollment ID: I20220404001832 |
| Provider Name | Paul J Padula |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093392524 PECOS PAC ID: 2466848064 Enrollment ID: I20220407001673 |
| Provider Name | Amelia Vera Tajik |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1801454491 PECOS PAC ID: 4486033271 Enrollment ID: I20220624001900 |
| Provider Name | Benjamin Michael Nelson |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1285371831 PECOS PAC ID: 9234519786 Enrollment ID: I20220630001609 |
| Provider Name | Denise Labelle |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1760859524 PECOS PAC ID: 6305195041 Enrollment ID: I20220728001767 |
| Provider Name | Rachel Johanson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215136817 PECOS PAC ID: 7618006198 Enrollment ID: I20220801001294 |
| Provider Name | Sohaib Siddiqui |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104480268 PECOS PAC ID: 5294119285 Enrollment ID: I20220824002972 |
| Provider Name | Justin Malette |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881336683 PECOS PAC ID: 5092199026 Enrollment ID: I20220825000575 |
| Provider Name | Maureen Mckenna |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1669674750 PECOS PAC ID: 2062710882 Enrollment ID: I20220825001528 |
| Provider Name | Amanda Montella |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487378451 PECOS PAC ID: 7719354885 Enrollment ID: I20221102000390 |
| Provider Name | Amanda S. Phillips |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1619590726 PECOS PAC ID: 9537588827 Enrollment ID: I20221104000323 |
| Provider Name | Michela Muggeo |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1295211043 PECOS PAC ID: 5092063529 Enrollment ID: I20221108002431 |
| Provider Name | Valerie Anderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013635184 PECOS PAC ID: 4183092380 Enrollment ID: I20221118002117 |
| Provider Name | Skyler Connor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235868969 PECOS PAC ID: 5698150423 Enrollment ID: I20221219002193 |
| Provider Name | Kyle Johnson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972846293 PECOS PAC ID: 5890083695 Enrollment ID: I20230216002791 |
| Provider Name | Anne Mcgrath |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508118811 PECOS PAC ID: 0244472355 Enrollment ID: I20230321002536 |
| Provider Name | Nishay Tariq |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720644909 PECOS PAC ID: 9133586274 Enrollment ID: I20230606001541 |
| Provider Name | Clara Brown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467144493 PECOS PAC ID: 1254798101 Enrollment ID: I20230607002898 |
| Provider Name | Afsana Jahan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1821698903 PECOS PAC ID: 1153794771 Enrollment ID: I20230612002458 |
| Provider Name | Chelsea Elizabeth Carver |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1609405034 PECOS PAC ID: 6204250814 Enrollment ID: I20230720003450 |
| Provider Name | Danielle Gagnon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164051249 PECOS PAC ID: 7113341769 Enrollment ID: I20230801000595 |
| Provider Name | Leon O. Back |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720558745 PECOS PAC ID: 1456713205 Enrollment ID: I20230811000168 |
| Provider Name | Elizabeth Stone |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1295362556 PECOS PAC ID: 5496176489 Enrollment ID: I20230825002707 |
| Provider Name | Rosa Constantino |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1437786142 PECOS PAC ID: 7214391978 Enrollment ID: I20230913002756 |
| Provider Name | Jared Astrow |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1386140721 PECOS PAC ID: 0941654016 Enrollment ID: I20230922001219 |
| Provider Name | Sharon Young Gu Lee |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1598290025 PECOS PAC ID: 7012362965 Enrollment ID: I20231012000702 |
| Provider Name | Linda A. V. Devincent |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881842813 PECOS PAC ID: 1355798679 Enrollment ID: I20231108002093 |
| Provider Name | Amy Augenstein |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912639550 PECOS PAC ID: 5698124238 Enrollment ID: I20231208000210 |
| Provider Name | Renee Heidi Miguel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285407460 PECOS PAC ID: 6709236771 Enrollment ID: I20240103002507 |
| Provider Name | Rachel Bailey-moore |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1679355143 PECOS PAC ID: 9830536788 Enrollment ID: I20240327001394 |
| Provider Name | Angela Gosselin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467202671 PECOS PAC ID: 8123467735 Enrollment ID: I20240416001196 |
| Provider Name | Vivian Ngoc-vy Bui |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124739057 PECOS PAC ID: 1052751005 Enrollment ID: I20240424003842 |
| Provider Name | Shauna Eileen Gaulin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568169423 PECOS PAC ID: 9830539642 Enrollment ID: I20240426001956 |
| Provider Name | Stacey Almeida |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023648516 PECOS PAC ID: 8022448117 Enrollment ID: I20240430000144 |
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