Provider Demographics
NPI:1962437871
Name:STEINBERG, JEREMY ERIC (PA)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:ERIC
Last Name:STEINBERG
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 CASS AVE
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-4705
Mailing Address - Country:US
Mailing Address - Phone:401-769-4100
Mailing Address - Fax:
Practice Address - Street 1:115 CASS AVE
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-4705
Practice Address - Country:US
Practice Address - Phone:401-769-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00419363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0007183OtherNEIGHBORHOOD
MA600132OtherTUFTS HEALTH PLAN
MA601512OtherHARVARD PILGRIM HEALTH
MAAP2591Medicare ID - Type Unspecified