Provider Demographics
NPI:1588648935
Name:LINCOLN PEDIATRIC ASSOC INC
Entity Type:Organization
Organization Name:LINCOLN PEDIATRIC ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SOWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-334-4021
Mailing Address - Street 1:6 BLACKSTONE VALLY PLACE
Mailing Address - Street 2:SUITE 306B
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865
Mailing Address - Country:US
Mailing Address - Phone:401-331-4021
Mailing Address - Fax:401-334-4886
Practice Address - Street 1:6 BLACKSTONE VALLY PLACE
Practice Address - Street 2:SUITE 306B
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865
Practice Address - Country:US
Practice Address - Phone:401-331-4021
Practice Address - Fax:401-334-4886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI6923208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7003409Medicaid
E03316Medicare UPIN