Provider Demographics
NPI:1659560902
Name:PAUL E SYDLOWSKI MD LLC
Entity Type:Organization
Organization Name:PAUL E SYDLOWSKI MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:EDMUND
Authorized Official - Last Name:SYDLOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-253-4300
Mailing Address - Street 1:576 METACOM AVE
Mailing Address - Street 2:UNIT 11A
Mailing Address - City:BRISTOL
Mailing Address - State:RI
Mailing Address - Zip Code:02809-5100
Mailing Address - Country:US
Mailing Address - Phone:401-253-4300
Mailing Address - Fax:401-253-9217
Practice Address - Street 1:576 METACOM AVE
Practice Address - Street 2:UNIT 11A
Practice Address - City:BRISTOL
Practice Address - State:RI
Practice Address - Zip Code:02809-5100
Practice Address - Country:US
Practice Address - Phone:401-253-4300
Practice Address - Fax:401-253-9217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI04705207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIPS50992Medicaid
MA740007OtherTUFTS HEALTH PLAN
RI0000026591OtherBLUE SHIELD OF RHODE ISLA
RIPS50992Medicaid