Bevivino, Jack R

Bevivino, Jack R is an individual health care provider with primary practice located at 120 Dudley Street Suite #201, Providence RI 02905-2431. He recently has only one registered license in Allopathic & Osteopathic Physicians / Plastic Surgery, which is considered as his primary health care specialty. Bevivino, Jack R can be contacted via phone (401) 521-9290.

Contact Information

Primary practice address
120 Dudley Street Suite #201 Providence RI 02905-2431
Phone: (401) 521-9290
Fax: (401) 521-9297
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Plastic Surgery 208200000X RIMD05259 Rhode Island

Profile Details

NPI number 1780705707
LBN Legal business name Bevivino, Jack R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 3rd, 2007
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1780705707 NPPES
Rhode Island Other 1300124 UNITED HEALTH CARE
Rhode Island MEDICAID 9002112 UNITED HEALTH CARE
Rhode Island Other 21126 UNITED HEALTH CARE

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