Basic Information
Provider Information
NPI: 1740419183
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PARKER
FirstName: ROBERT
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 16149
Address2:  
City: RUMFORD
State: RI
PostalCode: 029160697
CountryCode: US
TelephoneNumber: 4014539625
FaxNumber: 4014357069
Practice Location
Address1: 2 DUDLEY ST
Address2: SUITE 470
City: PROVIDENCE
State: RI
PostalCode: 029053236
CountryCode: US
TelephoneNumber: 4012721800
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/07/2009
LastUpdateDate: 06/18/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000XLP01813RIN Allopathic & Osteopathic PhysiciansSurgery 
208600000XMD14633RIY Allopathic & Osteopathic PhysiciansSurgery 

No ID Information.


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