Basic Information
| Provider Information | |||||||||
| NPI: | 1568486215 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOBAYASHI | ||||||||
| FirstName: | LEO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9484 | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029409484 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4018542500 | ||||||||
| FaxNumber: | 4018542519 | ||||||||
| Practice Location | |||||||||
| Address1: | 593 EDDY ST | ||||||||
| Address2: | CLAVERICK 2 | ||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029034923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4018542504 | ||||||||
| FaxNumber: | 4018542519 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 09/18/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD10927 | RI | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 12/29/2008 | 01 | MA | TUFTS HEALTH PLAN | OTHER | 409827 | 01 | RI | BLUECHIP | OTHER | 939025129 | 01 | RI | RI MEDICARE GROUP NUMBER | OTHER | 1568486215 | 01 | RI | NPI | OTHER | 7009948 | 05 | RI | MEDICAID | 930119434 | 01 | RAILROAD MEDICARE | OTHER | 01/11/2007 | 01 | RI | NHPRI | OTHER | 0177831 | 05 | MA | MEDICAID | 04.15.2009 | 01 | RI | UNITED HEALTHCARE | OTHER |