# UNIVERSITY PEDIATRICS DBA CHILDREN'S MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902292899
- **Authorized official:** MR. CHARLES M WHEELER III PPCNP-BC (PEDIATRIC NURSE PRACTIONER)
- **Authorized official phone:** (401) 633-1100

## Contact information

- **Practice address:** 100 HIGHLAND AVE, SUITE 201, PROVIDENCE, RI 02906-2740
- **Practice address phone:** (401) 633-1100
- **Practice address fax:** (401) 633-0047
- **Mailing address:** 100 HIGHLAND AVE, SUITE 201, PROVIDENCE, RI 02906-2740
- **Mailing address phone:** (401) 633-1100
- **Mailing address fax:** (401) 633-0047

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0200X | Pediatric Nurse Practitioner | APRN00401 | RI | Yes |

## Other

- **Enumeration date:** 04/08/2015
- **Last updated:** 04/08/2015