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825 Chalkstone Ave Providence RI 02908-4728 | |
| (401) 456-2000 | |
| (401) 456-2029 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 825 Chalkstone Ave, Providence, Rhode Island |
| Authorized Official Name and Position | Jeffrey Liebman (CEO) |
| Authorized Official Contact | 4014562001 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
825 Chalkstone Ave Providence RI 02908-4728 Ph: (401) 456-2000 | 825 Chalkstone Ave Providence RI 02908-4728 Ph: (401) 456-2000 |
| NPI Number | 1649009507 |
|---|---|
| Provider Enumeration Date | 07/30/2024 |
| Last Update Date | 07/31/2024 |
| Certification Date | 07/31/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649009507 | NPI | - | NPPES |
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