Provider Demographics
NPI:1093991945
Name:ROBERT B TRIVETT
Entity Type:Organization
Organization Name:ROBERT B TRIVETT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETIER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BOWEN
Authorized Official - Last Name:TRIVETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-295-9719
Mailing Address - Street 1:35 WEAVER RD
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-7135
Mailing Address - Country:US
Mailing Address - Phone:401-295-9719
Mailing Address - Fax:401-295-0150
Practice Address - Street 1:35 WEAVER RD
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-7135
Practice Address - Country:US
Practice Address - Phone:401-295-9719
Practice Address - Fax:401-295-0150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI4853207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIRT00205Medicaid