Provider Demographics
NPI:1649276494
Name:BARROS, PEDRO MARIANO (MD)
Entity type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:MARIANO
Last Name:BARROS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:33 STANIFORD ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-3105
Mailing Address - Country:US
Mailing Address - Phone:401-421-8800
Mailing Address - Fax:401-273-6510
Practice Address - Street 1:1407 S COUNTY TRL
Practice Address - Street 2:BLDG #4 SUITE 410
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-1652
Practice Address - Country:US
Practice Address - Phone:401-886-4040
Practice Address - Fax:401-886-4010
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD11144207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9024183Medicaid
119024183Medicare ID - Type Unspecified
G95208Medicare UPIN