| Immunology Center At The Miriam Hospital | |
|
180 Corliss St Ste E1 Providence RI 02904-2602 | |
| (401) 793-7401 | |
| Not Available |
| Full Name | Immunology Center At The Miriam Hospital |
|---|---|
| Speciality | Clinic/Center |
| Location | 180 Corliss St Ste E1, Providence, Rhode Island |
| Authorized Official Name and Position | Peter K Markell (EVP & CFO) |
| Authorized Official Contact | 4014447914 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Immunology Center At The Miriam Hospital 117 Ellenfield St Ste 101 Providence RI 02905-4541 Ph: (014) 446-7794 | Immunology Center At The Miriam Hospital 180 Corliss St Ste E1 Providence RI 02904-2602 Ph: (401) 793-7401 |
| NPI Number | 1275810434 |
|---|---|
| Provider Enumeration Date | 11/15/2011 |
| Last Update Date | 04/20/2023 |
| Certification Date | 04/20/2023 |
| Medicare PECOS PAC ID | 6901796408 |
|---|---|
| Medicare Enrollment ID | O20120405000306 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275810434 | NPI | - | NPPES |
| Provider Name | Josiah D Rich |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1972543049 PECOS PAC ID: 9638153273 Enrollment ID: I20040614000463 |
| Provider Name | John R Lonks |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1568409886 PECOS PAC ID: 9335123991 Enrollment ID: I20040614000632 |
| Provider Name | Susan Cu Uvin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1487609244 PECOS PAC ID: 1951385343 Enrollment ID: I20040615000018 |
| Provider Name | Jennifer Adelson Mitty |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1700830924 PECOS PAC ID: 6709860844 Enrollment ID: I20040616000079 |
| Provider Name | Maria D Mileno |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1982644100 PECOS PAC ID: 3274517313 Enrollment ID: I20040616000135 |
| Provider Name | Karen T Tashima |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1396740551 PECOS PAC ID: 2264416320 Enrollment ID: I20040616000253 |
| Provider Name | Edward J Wing |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1578503694 PECOS PAC ID: 7517852346 Enrollment ID: I20040621000035 |
| Provider Name | Timothy P Flanigan |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1679512354 PECOS PAC ID: 8820073331 Enrollment ID: I20040621000129 |
| Provider Name | Marguerite Ann Neill |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1164406930 PECOS PAC ID: 6800840901 Enrollment ID: I20050311000164 |
| Provider Name | Jerome M Larkin |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1306884689 PECOS PAC ID: 0446270722 Enrollment ID: I20051201000291 |
| Provider Name | Curt G Beckwith |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1730126624 PECOS PAC ID: 2163434424 Enrollment ID: I20060705000093 |
| Provider Name | Philip C Russell |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1073625794 PECOS PAC ID: 2466459391 Enrollment ID: I20061106000588 |
| Provider Name | Rami A Kantor |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1386883205 PECOS PAC ID: 1153488085 Enrollment ID: I20090320000431 |
| Provider Name | Erica J Hardy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1558390914 PECOS PAC ID: 1052480662 Enrollment ID: I20100805000217 |
| Provider Name | Tanya Orie Rogo |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1417123886 PECOS PAC ID: 7416139316 Enrollment ID: I20110315000029 |
| Provider Name | Megan Pinkston Camp |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1447560487 PECOS PAC ID: 7113100389 Enrollment ID: I20110325000010 |
| Provider Name | Philip A Chan |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1265658116 PECOS PAC ID: 8628232287 Enrollment ID: I20120611000388 |
| Provider Name | Gerard J Nau |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1104890813 PECOS PAC ID: 3971636101 Enrollment ID: I20140501001302 |
| Provider Name | Cheston B. Cunha |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1023246287 PECOS PAC ID: 5698908390 Enrollment ID: I20140505000854 |
| Provider Name | Anna C Hippchen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184971038 PECOS PAC ID: 5193942688 Enrollment ID: I20140806001765 |
| Provider Name | Christina D Scully |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1881989879 PECOS PAC ID: 8123248085 Enrollment ID: I20140929000726 |
| Provider Name | Francine Touzard Romo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104072214 PECOS PAC ID: 9234453937 Enrollment ID: I20150129001584 |
| Provider Name | Rebecca Marie Reece |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366614687 PECOS PAC ID: 6800111741 Enrollment ID: I20150217000758 |
| Provider Name | Amanda Jean Noska |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1093031692 PECOS PAC ID: 6901026913 Enrollment ID: I20150804004365 |
| Provider Name | Joseph Garland |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1144357583 PECOS PAC ID: 1355467150 Enrollment ID: I20150806010456 |
| Provider Name | Natasha R Rybak |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1932301330 PECOS PAC ID: 9133349855 Enrollment ID: I20160810001979 |
| Provider Name | Martha C Sanchez |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1144481201 PECOS PAC ID: 3375738180 Enrollment ID: I20160914000283 |
| Provider Name | Donald Rice |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1104189653 PECOS PAC ID: 8022327790 Enrollment ID: I20171025002205 |
| Provider Name | Michaela Ann Maynard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083090849 PECOS PAC ID: 3375852569 Enrollment ID: I20180306002639 |
| Provider Name | Jennie Elizabeth Johnson |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1578820502 PECOS PAC ID: 4789820150 Enrollment ID: I20180605001611 |
| Provider Name | Ralph Rogers |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1063824779 PECOS PAC ID: 9234356734 Enrollment ID: I20190513000665 |
| Provider Name | Su N Aung |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1649513805 PECOS PAC ID: 8921331547 Enrollment ID: I20190612003135 |
| Provider Name | Nicholas Tarantino |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1467090456 PECOS PAC ID: 6305267881 Enrollment ID: I20200609002554 |
| Provider Name | Sean Andrew Rebello |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669008728 PECOS PAC ID: 9234549320 Enrollment ID: I20201030000998 |
| Provider Name | Kevin G. Mirandou |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942826466 PECOS PAC ID: 6800206889 Enrollment ID: I20201103000162 |
| Provider Name | Molly Anne Moran |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336442540 PECOS PAC ID: 3870779416 Enrollment ID: I20210818001556 |
| Provider Name | Andrew C. Martina |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1891157442 PECOS PAC ID: 7618227687 Enrollment ID: I20210915001199 |
| Provider Name | Jonathan Liu |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750797247 PECOS PAC ID: 5496148835 Enrollment ID: I20220208002227 |
| Provider Name | Vincent Mariano |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1962931295 PECOS PAC ID: 7911276696 Enrollment ID: I20220531000083 |
| Provider Name | Leonardo Filipe Costa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124453386 PECOS PAC ID: 3274911185 Enrollment ID: I20220606002016 |
| Provider Name | Anuoluwapo A Shobayo |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1659895795 PECOS PAC ID: 7810232055 Enrollment ID: I20220609001767 |
| Provider Name | Calli Dogon |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1821511445 PECOS PAC ID: 3476910373 Enrollment ID: I20230608001284 |
| Provider Name | Leah Harvey |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1700248424 PECOS PAC ID: 9234424623 Enrollment ID: I20230611000103 |
| Provider Name | Louise Knapp |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134804578 PECOS PAC ID: 9739543968 Enrollment ID: I20230906003877 |
| Provider Name | Cecelia Odile Haffner Jatta |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740929207 PECOS PAC ID: 4587007133 Enrollment ID: I20240210000079 |
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