Provider Demographics
NPI:1477715209
Name:LYDIA L. KLUFAS MD
Entity type:Organization
Organization Name:LYDIA L. KLUFAS MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KLUFAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-724-7800
Mailing Address - Street 1:525 BROAD ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-6919
Mailing Address - Country:US
Mailing Address - Phone:401-724-7800
Mailing Address - Fax:401-727-0342
Practice Address - Street 1:525 BROAD ST
Practice Address - Street 2:SUITE 201
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-6919
Practice Address - Country:US
Practice Address - Phone:401-724-7800
Practice Address - Fax:401-727-0342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI8614174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI27294-6OtherBLUE CROSS
RI004913OtherBLUE CHIP
0300158OtherUNITED HEALTH
RI27294-6OtherBLUE CROSS