Provider Demographics
NPI:1205944956
Name:CONSTANTINE, ELSA ERIKA (MD)
Entity type:Individual
Prefix:
First Name:ELSA
Middle Name:ERIKA
Last Name:CONSTANTINE
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:PO BOX 9484
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02940-9484
Mailing Address - Country:US
Mailing Address - Phone:401-854-2500
Mailing Address - Fax:401-854-2519
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:CLAVERICK 2
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-444-4000
Practice Address - Fax:401-427-7795
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD11349207P00000X, 207PP0204X, 208000000X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI3790032562OtherMEDICARE NGS
RI01/14/2010OtherNHPRI
MA01/27/2009OtherTUFTS HEALTH PLAN
MA9003256Medicaid
RI1962455022OtherUEMF GROUP NPI
RI04/15/2009OtherUNITED HEALTHCARE
RI9003256Medicaid
RI939025129OtherRI MEDICARE GROUP NUMBER
RI1205944956OtherNPI
RI08/28/2007OtherBCBS
RI9003256Medicaid