Provider Demographics
NPI:1700837705
Name:KLONOWSKI, EVA (MD)
Entity Type:Individual
Prefix:DR
First Name:EVA
Middle Name:
Last Name:KLONOWSKI
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 1:1 RIVER ST.
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879
Mailing Address - Country:US
Mailing Address - Phone:401-783-0523
Mailing Address - Fax:401-783-9448
Practice Address - Street 1:1 RIVER ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-3214
Practice Address - Country:US
Practice Address - Phone:401-783-0523
Practice Address - Fax:401-783-9448
Is Sole Proprietor?:No
Enumeration Date:2006-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD05888207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI29044-5OtherBLUE CROSS RI
RI7007420Medicaid
RI01-02592OtherUNITED HEALTHCARE
RI405882OtherBLUE CHIP RI
RIB67624Medicare UPIN