Basic Information
| Provider Information | |||||||||
| NPI: | 1568667434 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARTOLOMEI | ||||||||
| FirstName: | KEITH | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1076 NORTH MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 02904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4018617711 | ||||||||
| FaxNumber: | 4014215710 | ||||||||
| Practice Location | |||||||||
| Address1: | 1076 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029045760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4018617711 | ||||||||
| FaxNumber: | 4014215710 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2007 | ||||||||
| LastUpdateDate: | 04/01/2014 | ||||||||
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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 | 207RN0300X | MD14161 | RI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | KB92869 | 05 | RI | MEDICAID |