Provider Demographics
NPI:1467495572
Name:EDEN, ROBERT EMANUEL (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:EMANUEL
Last Name:EDEN
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 1:197 RUMSTICK RD
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-4923
Mailing Address - Country:US
Mailing Address - Phone:401-245-9040
Mailing Address - Fax:
Practice Address - Street 1:100 HIGHLAND AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-2740
Practice Address - Country:US
Practice Address - Phone:401-633-1100
Practice Address - Fax:401-633-0047
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD08724208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIF91954Medicare UPIN