Provider Demographics
NPI:1487723458
Name:NEVOLA, CHAD PETER (MD, FAAP)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:PETER
Last Name:NEVOLA
Suffix:
Gender:M
Credentials:MD, FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:120 DUDLEY ST STE 105
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-2431
Mailing Address - Country:US
Mailing Address - Phone:401-273-9555
Mailing Address - Fax:401-861-4943
Practice Address - Street 1:120 DUDLEY ST STE 105
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-2431
Practice Address - Country:US
Practice Address - Phone:401-273-9555
Practice Address - Fax:401-861-4943
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD10281208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI2642815OtherFIRST HEALTH OF RI
RICN32566Medicaid
RI31505-8OtherBLUE CROSS BLUE SHIELD RI
RI3815OtherNHPRI
RI407401OtherBLUE CHIP OF RI
RI478834OtherTUFTS HEALTH PLAN
RI710058301OtherCIGNA HEALTH PLAN OF RI
RI1984965OtherUNITED HEALTH PLAN OF RI