Provider Demographics
NPI:1497743330
Name:MISKOVSKY, JOHN P (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:P
Last Name:MISKOVSKY
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 1:131 BEECHWOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860
Mailing Address - Country:US
Mailing Address - Phone:401-475-1999
Mailing Address - Fax:401-475-6933
Practice Address - Street 1:131 BEECHWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860
Practice Address - Country:US
Practice Address - Phone:401-475-1999
Practice Address - Fax:401-475-6932
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD10350207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9022171Medicaid
RI9022171Medicaid