Individual
RICHARD A PELOQUIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
100 BUTLER DR, PROVIDENCE, RI 02906-4862
(401) 277-0790
Mailing address
16 ARLINGTON DR, LINCOLN, RI 02865-1636
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA00096
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7006485
—
RI
01
—
979006370
MEDICARE PTAN
RI
Enumeration date
06/11/2006
Last updated
07/19/2024
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