Provider Demographics
NPI:1992846315
Name:UNIVERSITY FAMILY MEDICINE INC
Entity Type:Organization
Organization Name:UNIVERSITY FAMILY MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PIERRE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MANZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-398-0860
Mailing Address - Street 1:1351 S COUNTY TRL
Mailing Address - Street 2:SUITE 301
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-5083
Mailing Address - Country:US
Mailing Address - Phone:401-398-0860
Mailing Address - Fax:401-398-0861
Practice Address - Street 1:1351 S COUNTY TRL
Practice Address - Street 2:SUITE 301
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-5083
Practice Address - Country:US
Practice Address - Phone:401-398-0860
Practice Address - Fax:401-398-0861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI089004231Medicare ID - Type Unspecified