Provider Demographics
NPI:1518962034
Name:TRAFFORD, PATRICIA A (PAC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:TRAFFORD
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 OPHELIA ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02909-5820
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:790 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5706
Practice Address - Country:US
Practice Address - Phone:401-455-3574
Practice Address - Fax:401-455-3624
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00024363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIR76950Medicare UPIN
RI979005517Medicare PIN
RI979003365Medicare ID - Type Unspecified
RI979005518Medicare PIN