Provider Demographics
NPI:1801896378
Name:MICHAUD, PIERRE ROSS (MD)
Entity type:Individual
Prefix:DR
First Name:PIERRE
Middle Name:ROSS
Last Name:MICHAUD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 CENTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4381
Mailing Address - Country:US
Mailing Address - Phone:401-828-4840
Mailing Address - Fax:401-828-9570
Practice Address - Street 1:875 CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4381
Practice Address - Country:US
Practice Address - Phone:401-828-4840
Practice Address - Fax:401-828-9570
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-27
Last Update Date:2010-06-07
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
RIMD10018208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI693649OtherTUFTS
RI5726691OtherAETNA
RI1670804001OtherCIGNA
RI210117OtherBCBSRI
RI405065OtherBLUE CHIP
RIPM54867Medicaid
RI1300068OtherUNITED HEALTH CARE
F77555Medicare UPIN
RI1670804001OtherCIGNA
RIPM54867Medicaid