Provider Demographics
NPI:1801863337
Name:PIETTE, PHILIP JOSEPH (PA-C, MS)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:JOSEPH
Last Name:PIETTE
Suffix:
Gender:M
Credentials:PA-C, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 CAMERON ST
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02861-1713
Mailing Address - Country:US
Mailing Address - Phone:978-755-6934
Mailing Address - Fax:
Practice Address - Street 1:55 CAMERON ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02861-1713
Practice Address - Country:US
Practice Address - Phone:978-755-6934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00297363A00000X
MA1591363A00000X
CT002523363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI979004439Medicare UPIN
MAAP229801Medicare PIN