Provider Demographics
NPI:1770689002
Name:CHAD P. NEVOLA, MD, INC.
Entity Type:Organization
Organization Name:CHAD P. NEVOLA, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE STOCKHOLDER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:NEVOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-273-9555
Mailing Address - Street 1:120 DUDLEY ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-2436
Mailing Address - Country:US
Mailing Address - Phone:401-273-9555
Mailing Address - Fax:401-861-4943
Practice Address - Street 1:120 DUDLEY ST
Practice Address - Street 2:SUITE 105
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-2436
Practice Address - Country:US
Practice Address - Phone:401-273-9555
Practice Address - Fax:401-861-4943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD10281208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI2642815OtherFIRST HEALTH OF RI
RI407860OtherHCVM OF RI
RI31505-8OtherBLUE CROSS/BLUE SHIELD RI
RI710058301OtherCIGNA
RICN32566Medicaid
RI1984965OtherUNITED HEALTH PLAN OF RI
RI3815OtherNEIGHBORHOOD HEALTH PLAN
RI407401OtherBLUE CHIP OF RI
RI478834OtherTUFTS HEALTH PLAN
RI407860OtherHCVM OF RI