Provider Demographics
NPI:1366674509
Name:KESTIN, ANITA SUSAN (MPH)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:SUSAN
Last Name:KESTIN
Suffix:
Gender:F
Credentials:MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 POINT ST
Mailing Address - Street 2:SUITE 213
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4771
Mailing Address - Country:US
Mailing Address - Phone:401-350-5752
Mailing Address - Fax:
Practice Address - Street 1:167 POINT ST
Practice Address - Street 2:SUITE 213
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4771
Practice Address - Country:US
Practice Address - Phone:401-350-5752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-21
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI060780282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI060780OtherSTATE LICENSE
RIA58353Medicare UPIN