Provider Demographics
NPI:1013930536
Name:RIVERA, DAVID R (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:RIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:45 WELLS ST
Mailing Address - Street 2:SUITE 2020
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-2927
Mailing Address - Country:US
Mailing Address - Phone:401-596-4959
Mailing Address - Fax:401-596-6896
Practice Address - Street 1:45 WELLS ST
Practice Address - Street 2:SUITE 2020
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-2927
Practice Address - Country:US
Practice Address - Phone:401-596-4959
Practice Address - Fax:401-596-6896
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-11-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
RIMD9236207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT003099638Medicaid
RI7058937Medicaid
RIG29988Medicare UPIN
CT003099638Medicaid