Provider Demographics
NPI:1508964636
Name:GHOREISHI, SIAVASH (MD)
Entity Type:Individual
Prefix:MR
First Name:SIAVASH
Middle Name:
Last Name:GHOREISHI
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 1:5835 POST ROAD
Mailing Address - Street 2:PLAZA 2 SUITE 110
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-2154
Mailing Address - Country:US
Mailing Address - Phone:401-885-3390
Mailing Address - Fax:401-885-8713
Practice Address - Street 1:5835 POST ROAD
Practice Address - Street 2:PLAZA 2 SUITE 110
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-2154
Practice Address - Country:US
Practice Address - Phone:401-885-3390
Practice Address - Fax:401-885-8713
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD06842208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
201159OtherBLUE CHIP
2684OtherBC
406185OtherTUTTS
1200203OtherUHC
RISG00062Medicaid
RISG00062Medicaid