Provider Demographics
NPI:1477728624
Name:ERIC P. BERTHIAUME MEDICAL INC.
Entity Type:Organization
Organization Name:ERIC P. BERTHIAUME MEDICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:P
Authorized Official - Last Name:BERTHIAUME
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-421-8800
Mailing Address - Street 1:1407 SOUTH COUNTY TRAIL
Mailing Address - Street 2:BUILDING 4 SUITE 410
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818
Mailing Address - Country:US
Mailing Address - Phone:401-886-4040
Mailing Address - Fax:401-886-4010
Practice Address - Street 1:1407 SOUTH COUNTY TRAIL
Practice Address - Street 2:BUILDING 4 SUITE 410
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818
Practice Address - Country:US
Practice Address - Phone:401-886-4040
Practice Address - Fax:401-886-4010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI11821207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RII28504Medicare UPIN
709006140Medicare PIN