Provider Demographics
NPI:1578588067
Name:BELIVEAU, WILLIAM J (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:BELIVEAU
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 1:1524 ATWOOD AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:JOHNSON
Mailing Address - State:RI
Mailing Address - Zip Code:02919
Mailing Address - Country:US
Mailing Address - Phone:401-272-1900
Mailing Address - Fax:401-453-3049
Practice Address - Street 1:1524 ATWOOD AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:JOHNSON
Practice Address - State:RI
Practice Address - Zip Code:02919
Practice Address - Country:US
Practice Address - Phone:401-272-1900
Practice Address - Fax:401-453-3049
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI6932207R00000X, 207RC0200X
RIRI 6932207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
200895OtherBCHIP
397OtherBC
RI9000397Medicaid
110035482OtherRR MEDICARE
4800121OtherUHP
RI9000397Medicaid
RI007002272Medicare UPIN
4800121OtherUHP
299000397Medicare ID - Type Unspecified
RI007059392Medicare PIN