Provider Demographics
NPI:1346223245
Name:ENTIN, ESTHER J (MD)
Entity Type:Individual
Prefix:
First Name:ESTHER
Middle Name:J
Last Name:ENTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 BREWSTER ST
Mailing Address - Street 2:DEPARTMENT OF PEDIATRICS
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-4400
Mailing Address - Country:US
Mailing Address - Phone:401-729-6200
Mailing Address - Fax:401-729-6203
Practice Address - Street 1:111 BREWSTER ST
Practice Address - Street 2:DEPARTMENT OF PEDIATRICS
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-4400
Practice Address - Country:US
Practice Address - Phone:401-729-6200
Practice Address - Fax:401-729-6203
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD05544208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9006299Medicaid
RIC89944Medicare UPIN