Provider Demographics
NPI:1164636890
Name:AQUIDNECK PODIATRY LTD
Entity Type:Organization
Organization Name:AQUIDNECK PODIATRY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AQUIDNECK PODIATRY LTD
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:CORNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:401-846-2800
Mailing Address - Street 1:55 MEMORIAL BOULEVARD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-3679
Mailing Address - Country:US
Mailing Address - Phone:401-846-2800
Mailing Address - Fax:401-849-4899
Practice Address - Street 1:55 MEMORIAL BOULEVARD
Practice Address - Street 2:SUITE 7
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-3679
Practice Address - Country:US
Practice Address - Phone:401-846-2800
Practice Address - Fax:401-849-4899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDPM 00195213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI2700178OtherUNITED HEALTH
RI71215OtherBCBS
RI9007121Medicaid
RI0815320001Medicare NSC
T53879Medicare UPIN