Provider Demographics
NPI:1982758207
Name:PETER J BELLAFIORE MD, INC
Entity type:Organization
Organization Name:PETER J BELLAFIORE MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:BELLAFIORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-789-4885
Mailing Address - Street 1:70 KENYON AVE
Mailing Address - Street 2:SUITE 321
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-4239
Mailing Address - Country:US
Mailing Address - Phone:401-789-4885
Mailing Address - Fax:401-792-0201
Practice Address - Street 1:70 KENYON AVE
Practice Address - Street 2:SUITE 321
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-4239
Practice Address - Country:US
Practice Address - Phone:401-789-4885
Practice Address - Fax:401-792-0201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD89242084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI20877OtherBCBS OF RI