Provider Demographics
NPI:1316944127
Name:KURKCHUBASCHE, ARLET G (MD)
Entity type:Individual
Prefix:
First Name:ARLET
Middle Name:G
Last Name:KURKCHUBASCHE
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:PO BOX 16149
Mailing Address - Street 2:
Mailing Address - City:RUMFORD
Mailing Address - State:RI
Mailing Address - Zip Code:02916-0697
Mailing Address - Country:US
Mailing Address - Phone:401-854-2428
Mailing Address - Fax:401-435-7069
Practice Address - Street 1:2 DUDLEY STREET
Practice Address - Street 2:SUITE 190
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905
Practice Address - Country:US
Practice Address - Phone:401-421-1939
Practice Address - Fax:401-868-2319
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD96132086S0120X
RIRI96132086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3173780Medicaid
RI9020611Medicaid
G35010Medicare UPIN
MA3173780Medicaid