Provider Demographics
NPI:1902864218
Name:RIVERSIDE INTERNAL MEDICINE PLC
Entity Type:Organization
Organization Name:RIVERSIDE INTERNAL MEDICINE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:J
Authorized Official - Last Name:KENDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-674-6744
Mailing Address - Street 1:PO BOX 416
Mailing Address - Street 2:
Mailing Address - City:ASCUTNEY
Mailing Address - State:VT
Mailing Address - Zip Code:05030
Mailing Address - Country:US
Mailing Address - Phone:802-674-6744
Mailing Address - Fax:802-674-6744
Practice Address - Street 1:14 ASCUTNEY PLACE
Practice Address - Street 2:UNIT B2
Practice Address - City:ASCUTNEY
Practice Address - State:VT
Practice Address - Zip Code:05030
Practice Address - Country:US
Practice Address - Phone:802-674-6744
Practice Address - Fax:802-674-6744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty