Provider Demographics
NPI:1558403550
Name:NARRAGANSETT BAY PEDIATRICS, INC.
Entity Type:Organization
Organization Name:NARRAGANSETT BAY PEDIATRICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CELESTE
Authorized Official - Middle Name:C
Authorized Official - Last Name:CORCORAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-789-5924
Mailing Address - Street 1:70 KENYON AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-4239
Mailing Address - Country:US
Mailing Address - Phone:401-789-5924
Mailing Address - Fax:401-782-1770
Practice Address - Street 1:70 KENYON AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-4239
Practice Address - Country:US
Practice Address - Phone:401-789-5924
Practice Address - Fax:401-782-1770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RINB04039Medicaid
RI0668OtherNEIGHBORHOOD HEALTH PLAN
RI155-7OtherBLUE CROSS GROUP NUMBER
RI201468OtherBLUE CHIP GROUP NUMBER