Basic Information
| Provider Information | |||||||||
| NPI: | 1861618290 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CENTER FOR ORTHOPEDICS INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1524 ATWOOD AVE STE 140 | ||||||||
| Address2: | |||||||||
| City: | JOHNSTON | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029193288 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013516200 | ||||||||
| FaxNumber: | 4013516201 | ||||||||
| Practice Location | |||||||||
| Address1: | 1524 ATWOOD AVE STE 140 | ||||||||
| Address2: | |||||||||
| City: | JOHNSTON | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029193288 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013516200 | ||||||||
| FaxNumber: | 4013516201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2007 | ||||||||
| LastUpdateDate: | 04/21/2010 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BUONANNO | ||||||||
| AuthorizedOfficialFirstName: | ANTHONY | ||||||||
| AuthorizedOfficialMiddleName: | ROBERT | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 4013516200 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 5345 | RI | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 5978120 | 01 | AETNA | OTHER | 103714900 | 01 | U.S. DEPT. OF LABOR-WC | OTHER | R000315 | 01 | TRICARE/CHAMPUS | OTHER | TC-03699 | 05 | RI | MEDICAID | CD1829 | 01 | RAILROAD MEDICARE | OTHER | KH55 | 01 | MA | HARVARD PILGRIM HEALTH | OTHER | 1024 | 01 | RI | NEIGHBORHOOD HEALTH PLANS | OTHER | 731121 | 01 | MA | TUFTS | OTHER |