Provider Demographics
NPI:1205008851
Name:RICHARD M DELSESTO MD MS LTD
Entity Type:Organization
Organization Name:RICHARD M DELSESTO MD MS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:DELSESTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-471-6510
Mailing Address - Street 1:3461 S COUNTY TRL
Mailing Address - Street 2:SUITE303
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-1465
Mailing Address - Country:US
Mailing Address - Phone:401-471-6510
Mailing Address - Fax:401-471-6530
Practice Address - Street 1:3461 S COUNTY TRL
Practice Address - Street 2:SUITE 303
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-1465
Practice Address - Country:US
Practice Address - Phone:401-471-6510
Practice Address - Fax:401-471-6530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD10080207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI255695OtherBLUE CROSS
RI0407376OtherUNITED HEALTH CARE
RI255695OtherBLUE CROSS
RI119006165Medicare PIN