Provider Demographics
NPI:1598752024
Name:LEY, CHRISTOPHER W (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:W
Last Name:LEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:148 W RIVER ST
Mailing Address - Street 2:SUITE 22B
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-2615
Mailing Address - Country:US
Mailing Address - Phone:401-572-3887
Mailing Address - Fax:401-865-6192
Practice Address - Street 1:148 W RIVER ST
Practice Address - Street 2:SUITE 22B
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-2615
Practice Address - Country:US
Practice Address - Phone:401-572-3887
Practice Address - Fax:401-865-6192
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD06618207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI709003711OtherGROUP MEDICARE
RI110039297OtherRR MEDICARE
RI7000367Medicaid
RI26-4839161OtherTAX ID
RI709003711OtherGROUP MEDICARE