Provider Demographics
NPI:1225227200
Name:BLACKSTONE VALLEY PEDIATRICS
Entity Type:Organization
Organization Name:BLACKSTONE VALLEY PEDIATRICS
Other - Org Name:PETER T.YASIGIAN MD PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-658-2525
Mailing Address - Street 1:2 MEEHAN LN
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-1413
Mailing Address - Country:US
Mailing Address - Phone:401-658-2525
Mailing Address - Fax:401-658-3031
Practice Address - Street 1:2 MEEHAN LN
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-1413
Practice Address - Country:US
Practice Address - Phone:401-658-2525
Practice Address - Fax:401-658-3031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty