Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DEN03480 | RI |
Y | 213EG0000X | General Practice | DEN03480 | RI |
NPI | 1003460858 |
---|---|
Provider Name | Dr. Daniel Mackenzie Pickar |
First Address | Cranston, RI 02920-6429 |
Second Address | Cranston, RI 02920-6429 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2019 |
Last Update Date | 17/08/2020 |