Provider Demographics
NPI:1164730065
Name:UNIVERSITY OTOLARYNGOLOGY HEAD & NECK SURGERY INC.
Entity Type:Organization
Organization Name:UNIVERSITY OTOLARYNGOLOGY HEAD & NECK SURGERY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:T
Authorized Official - Last Name:NIGRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-272-2300
Mailing Address - Street 1:116 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-3566
Mailing Address - Country:US
Mailing Address - Phone:401-782-4400
Mailing Address - Fax:401-782-4994
Practice Address - Street 1:116 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-3566
Practice Address - Country:US
Practice Address - Phone:401-782-4400
Practice Address - Fax:401-782-4994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-14
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI9418207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9020447Medicaid
F54934Medicare UPIN
RI9020447Medicaid