Provider Demographics
NPI:1063629129
Name:CONCILIO PEDIATRICS
Entity Type:Organization
Organization Name:CONCILIO PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONCILIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-334-2949
Mailing Address - Street 1:132 OLD RIVER RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-1161
Mailing Address - Country:US
Mailing Address - Phone:401-334-2949
Mailing Address - Fax:401-334-0867
Practice Address - Street 1:132 OLD RIVER RD
Practice Address - Street 2:SUITE 203
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-1161
Practice Address - Country:US
Practice Address - Phone:401-334-2949
Practice Address - Fax:401-334-0867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD081722080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty