Individual
DR. JOHN JEFFERYS BANDOLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
70 KENYON AVE, SUITE 326, WAKEFIELD, RI 02879-4239
(401) 789-8543
(401) 782-8766
Mailing address
70 KENYON AVE, SUITE 326, WAKEFIELD, RI 02879-4239
(401) 789-8543
(401) 782-8766
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
RI5619
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000000094
RHODE ISLAND BLUE CROSS AND BLUE SHIELD
RI
01
—
000196
RHODE ISLAND BLUE CHIP
RI
05
—
1D9000094
—
RI
Enumeration date
08/31/2006
Last updated
03/18/2010
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