Provider Demographics
NPI:1376536664
Name:BAZIOTIS, PETER E (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:E
Last Name:BAZIOTIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:200 MAIN ST
Mailing Address - Street 2:SUITE 350
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-4119
Mailing Address - Country:US
Mailing Address - Phone:401-726-7300
Mailing Address - Fax:401-726-7330
Practice Address - Street 1:111 BREWSTER ST
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-4400
Practice Address - Country:US
Practice Address - Phone:401-726-7300
Practice Address - Fax:401-726-7330
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD08592207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI402881OtherBLUECHIP
RI2378OtherNEIGHBORHOOD HEALTH
RI3201511OtherMASSACHUSETTS MEDICAID
RI7004143Medicaid
RI2822OtherPILGRAM HEALTHCARE
RI8592OtherTUFTS HEALTH PLAN
RI7004143Medicaid