Provider Demographics
NPI:1801854054
Name:PEDVIS-LEFTICK, ANITA ESTHER (MD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:ESTHER
Last Name:PEDVIS-LEFTICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 S COUNTY TRL
Mailing Address - Street 2:SUITE 302
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-5105
Mailing Address - Country:US
Mailing Address - Phone:401-886-5663
Mailing Address - Fax:401-884-9043
Practice Address - Street 1:1351 S COUNTY TRL
Practice Address - Street 2:SUITE 302
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-5105
Practice Address - Country:US
Practice Address - Phone:401-886-5663
Practice Address - Fax:401-884-9043
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI10175207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9002857Medicaid
RI007057495Medicare ID - Type Unspecified
RI0070574951Medicare PIN
RI9002857Medicaid