Provider Demographics
NPI:1881625788
Name:PLOVER, REGINA (MD)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:PLOVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:
Other - Last Name:PLOVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1660 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02905-2730
Mailing Address - Country:US
Mailing Address - Phone:401-784-8281
Mailing Address - Fax:401-781-8285
Practice Address - Street 1:1660 BROAD ST
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02905-2730
Practice Address - Country:US
Practice Address - Phone:401-784-8281
Practice Address - Fax:401-781-8285
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD08149207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H72530Medicare UPIN