Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0202X | Pediatric Cardiologist | 223230 | MA |
Y | 2080P0202X | Pediatric Cardiologist | MD11479 | RI |
NPI | 1013989425 |
---|---|
Provider Name | Sara Regan Ford |
First Address | Providence, RI 02903-4923 |
Second Address | Providence, RI 02903-4141 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2006 |
Last Update Date | 04/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I16820 | (02) | RI |
SR54274 | (05) | RI |