Provider Demographics
NPI:1396825576
Name:TRIVEDI, AMAL NITIN (MD)
Entity Type:Individual
Prefix:DR
First Name:AMAL
Middle Name:NITIN
Last Name:TRIVEDI
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:DEPARTMENT OF COMMUNITY HEALTH, BROWN UNIVERSITY
Mailing Address - Street 2:BOX G
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906
Mailing Address - Country:US
Mailing Address - Phone:401-863-9941
Mailing Address - Fax:
Practice Address - Street 1:PROVIDENCE VA MEDICAL CENTER
Practice Address - Street 2:830 CHALKSTONE AVENUE
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908
Practice Address - Country:US
Practice Address - Phone:401-863-9941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213648207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
38520Medicare UPIN