Provider Demographics
NPI:1619067386
Name:PILGRIM PARK MEDICAL ASSOCIATES LTD.
Entity Type:Organization
Organization Name:PILGRIM PARK MEDICAL ASSOCIATES LTD.
Other - Org Name:PILGRIM PARK PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:GRANDE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:401-941-2999
Mailing Address - Street 1:1243 POST RD
Mailing Address - Street 2:UNIT A
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-3221
Mailing Address - Country:US
Mailing Address - Phone:401-941-2999
Mailing Address - Fax:401-941-5830
Practice Address - Street 1:1243 POST RD
Practice Address - Street 2:UNIT A
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-3221
Practice Address - Country:US
Practice Address - Phone:401-941-2999
Practice Address - Fax:401-941-5830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9003103Medicare PIN