Provider Demographics
NPI:1144773623
Name:CAVICCHIO PODIATRY LLC
Entity Type:Organization
Organization Name:CAVICCHIO PODIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:M
Authorized Official - Last Name:CAVICCHIO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:401-312-9999
Mailing Address - Street 1:2 WAKE ROBIN RD
Mailing Address - Street 2:UNIT 203
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-4295
Mailing Address - Country:US
Mailing Address - Phone:401-312-9999
Mailing Address - Fax:401-312-0416
Practice Address - Street 1:2 WAKE ROBIN RD
Practice Address - Street 2:UNIT 203
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-4295
Practice Address - Country:US
Practice Address - Phone:401-312-9999
Practice Address - Fax:401-312-0416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDPM 206213EP1101X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI2700124OtherUNITED HEALTH CARE
RI9007036Medicaid
RI0536455OtherAETNA
RI70366OtherBLUE CROSS BLUE SHIELD
RIP12001350OtherMULTIPLAN
MA770036OtherBLUE CROSS BLUE SHIELD
RI000432OtherBLUE CHIP
RI480001530OtherRAILROAD MEDICARE
RI0475951001OtherCIGNA
RI2700124OtherUNITED HEALTH CARE
MA770036OtherBLUE CROSS BLUE SHIELD