Provider Demographics
NPI:1104048396
Name:VALLEY PRIMARY CARE INC
Entity type:Organization
Organization Name:VALLEY PRIMARY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:V
Authorized Official - Last Name:DEL GUERCIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-847-7772
Mailing Address - Street 1:294 VALLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842
Mailing Address - Country:US
Mailing Address - Phone:401-847-7772
Mailing Address - Fax:401-846-4959
Practice Address - Street 1:294 VALLEY ROAD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842
Practice Address - Country:US
Practice Address - Phone:401-847-7772
Practice Address - Fax:401-846-4959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD07423207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9020091Medicaid
RI9020091Medicaid
RIE12404Medicare UPIN