Organization
UNIVERSITY PLASTIC SURGEONS INC
Active
Other names
University Plastic Surgery Associates Inc
Organization subpart
No
Provider details
NPI number
Authorized official
JACK R BEVIVINO MD (PRESIDENT)
(401) 521-9290
Entity
Organization
Contact information
Practice address
120 DUDLEY STREET, SUITE #201, PROVIDENCE, RI 02905
(401) 521-9290
(401) 521-9297
Mailing address
120 DUDLEY STREET, SUITE #201, PROVIDENCE, RI 02905
(401) 521-9290
(401) 521-9297
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
RIMD05259
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1300124
UNITED HEALTH CARE
RI
01
—
21126
BCBS
RI
05
—
9002112
—
RI
Enumeration date
11/29/2006
Last updated
08/22/2020
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