| Summit Medical Group | |
|
100 Highland Ave Ste 307 Providence RI 02906-2753 | |
| (401) 331-5320 | |
| (401) 331-6168 |
| Full Name | Summit Medical Group |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 100 Highland Ave Ste 307, Providence, Rhode Island |
| Authorized Official Name and Position | Marvin Stuart Kerzner (MEDICAL DIRECTOR) |
| Authorized Official Contact | 4013315320 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Summit Medical Group 100 Highland Ave Ste 307 Providence RI 02906-2753 Ph: (401) 331-5320 | Summit Medical Group 100 Highland Ave Ste 307 Providence RI 02906-2753 Ph: (401) 331-5320 |
| NPI Number | 1235275207 |
|---|---|
| Provider Enumeration Date | 01/29/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235275207 | NPI | - | NPPES |
| 847-1 | Other | RI | BLUE CROSS |
| 9000847 | Medicaid | RI | |
| 2059883 | Other | RI | AETNA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | RI3593 (Rhode Island) | Primary |
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