Provider Demographics
NPI:1912992645
Name:MIGLIORI, SIDNEY PREMER (MD)
Entity Type:Individual
Prefix:
First Name:SIDNEY
Middle Name:PREMER
Last Name:MIGLIORI
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 1:725 RESERVOIR AVE
Mailing Address - Street 2:NUMBER 101
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-4448
Mailing Address - Country:US
Mailing Address - Phone:401-944-3800
Mailing Address - Fax:401-944-1342
Practice Address - Street 1:725 RESERVOIR AVE
Practice Address - Street 2:NUMBER 101
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-4448
Practice Address - Country:US
Practice Address - Phone:401-944-3800
Practice Address - Fax:401-944-1342
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD09084207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7008852Medicaid
RI32298-0OtherRI BLUE CROSS
RI1912992645OtherDURABLE
RI400484OtherCHIP
RI400484OtherCHIP
F84684Medicare UPIN