Provider Demographics
NPI:1013219492
Name:CENTER FOR PLASTIC AND HAND SURGERY PC
Entity Type:Organization
Organization Name:CENTER FOR PLASTIC AND HAND SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DICICCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:4016-320-4702
Mailing Address - Street 1:235 PLAIN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-3240
Mailing Address - Country:US
Mailing Address - Phone:401-632-4700
Mailing Address - Fax:401-632-4704
Practice Address - Street 1:235 PLAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-3240
Practice Address - Country:US
Practice Address - Phone:401-632-4700
Practice Address - Fax:401-632-4704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI 12444208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RISS73819Medicaid
RISS73819Medicaid