Provider Demographics
NPI:1487852356
Name:ANGELO B PHARMAKIDIS MD PHD
Entity Type:Organization
Organization Name:ANGELO B PHARMAKIDIS MD PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EFFIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PHARMAKIDIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:4013-530-7332
Mailing Address - Street 1:16-37 MINERAL SPRING AVENUE
Mailing Address - Street 2:
Mailing Address - City:N PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904
Mailing Address - Country:US
Mailing Address - Phone:401-353-7330
Mailing Address - Fax:401-354-4760
Practice Address - Street 1:16-37 MINERAL SPRING AVENUE
Practice Address - Street 2:
Practice Address - City:N PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904
Practice Address - Country:US
Practice Address - Phone:401-353-7330
Practice Address - Fax:401-354-4760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI5637207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9001041Medicare ID - Type Unspecified
B74295Medicare UPIN