Provider Demographics
NPI:1083638282
Name:BARON, JEFFREY FREDRIC (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:FREDRIC
Last Name:BARON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 FERRIS ST
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02861-3454
Mailing Address - Country:US
Mailing Address - Phone:401-727-1880
Mailing Address - Fax:401-729-1784
Practice Address - Street 1:101 FERRIS ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02861-3454
Practice Address - Country:US
Practice Address - Phone:401-727-1880
Practice Address - Fax:401-729-1784
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI6142207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9001554Medicaid
RI119001554Medicare ID - Type UnspecifiedMEDICARE
RIC90606Medicare UPIN