Provider Demographics
NPI:1558317008
Name:POSHKUS, KRISTIN M (MD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:M
Last Name:POSHKUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1672 S COUNTY TRL
Mailing Address - Street 2:SUITE 303
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-5098
Mailing Address - Country:US
Mailing Address - Phone:401-884-0020
Mailing Address - Fax:401-884-0019
Practice Address - Street 1:1672 S COUNTY TRL
Practice Address - Street 2:SUITE 303
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-5098
Practice Address - Country:US
Practice Address - Phone:401-884-0020
Practice Address - Fax:401-884-0019
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI11455207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7056504Medicaid
RI7056504Medicaid
RII08214Medicare UPIN