Provider Demographics
NPI:1801587787
Name:PRESCOD, MARIA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:PRESCOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 OLD LOUISQUISSET PIKE STE A103
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-4509
Mailing Address - Country:US
Mailing Address - Phone:401-602-1636
Mailing Address - Fax:
Practice Address - Street 1:1525 OLD LOUISQUISSET PIKE STE A103
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-4509
Practice Address - Country:US
Practice Address - Phone:401-602-1636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPMV-594347C00000X, 342000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company
No347C00000XTransportation ServicesPrivate Vehicle