Provider Demographics
NPI:1093889214
Name:UNIVERSITY PULMONARY ASSOCIATES
Entity Type:Organization
Organization Name:UNIVERSITY PULMONARY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-886-7910
Mailing Address - Street 1:1407 SOUTH COUNTY TRAIL
Mailing Address - Street 2:BUILDING 4, 3RD FLOOR, SUITE 430A
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818
Mailing Address - Country:US
Mailing Address - Phone:401-886-7910
Mailing Address - Fax:401-886-7913
Practice Address - Street 1:1407 SOUTH COUNTY TRAIL
Practice Address - Street 2:BUILDING 4, 3RD FLOOR, SUITE 430A
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818
Practice Address - Country:US
Practice Address - Phone:401-886-7910
Practice Address - Fax:401-886-7913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIUP46153Medicaid
RI299081053Medicare ID - Type Unspecified