Provider Demographics
NPI:1275502635
Name:POGACAR, PETER R (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:R
Last Name:POGACAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1377 S COUNTY TRL
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-5082
Mailing Address - Country:US
Mailing Address - Phone:401-884-8900
Mailing Address - Fax:401-884-9199
Practice Address - Street 1:1377 S COUNTY TRL
Practice Address - Street 2:SUITE 2B
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-5082
Practice Address - Country:US
Practice Address - Phone:401-884-8900
Practice Address - Fax:401-884-9199
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD 11655208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI412754OtherBC/BS-RI BLUE CHIP
RI7666682OtherAETNA/ US HEALTHCARE
RIAA38905OtherHPHC
RI478754OtherTUFTS
RI31222OtherNHP-RI
RI0000023951OtherBC/BS-RI
RI3867308OtherAETNA/US HEALTHCARE HMO
RI3817423OtherCIGNA
RII 26127Medicare UPIN