Provider Demographics
NPI:1407928179
Name:ENDOVASCULAR & INTERVENTIONAL ASSOCIATES INC
Entity Type:Organization
Organization Name:ENDOVASCULAR & INTERVENTIONAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LANDY
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:PAOLELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-295-8655
Mailing Address - Street 1:1130 TEN ROD RD
Mailing Address - Street 2:D201
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-4161
Mailing Address - Country:US
Mailing Address - Phone:401-295-8655
Mailing Address - Fax:
Practice Address - Street 1:455 TOLL GATE RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2759
Practice Address - Country:US
Practice Address - Phone:401-737-7010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI63152085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9020277Medicaid
CA9020277Medicaid