Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | DO00566 | RI |
NPI | 1134166960 |
---|---|
Provider Name | Dr. George J Pasquarello III |
First Address | Providence, RI 02901-1119 |
Second Address | East Greenwich, RI 02818-1627 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 14/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7057128 | (05) | RI |
G20876 | (02) | RI |