Provider Demographics
NPI:1619936028
Name:DERMATOLOGY CARE SPECIALISTS INC
Entity Type:Organization
Organization Name:DERMATOLOGY CARE SPECIALISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CECCOFIGLIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-739-8021
Mailing Address - Street 1:647 JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1318
Mailing Address - Country:US
Mailing Address - Phone:401-739-8021
Mailing Address - Fax:401-739-8045
Practice Address - Street 1:647 JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1318
Practice Address - Country:US
Practice Address - Phone:401-739-8021
Practice Address - Fax:401-739-8045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI331207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIA59115Medicare UPIN
RI1518053271Medicare PIN