Organization
SUMMIT MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARVIN STUART KERZNER MD (MEDICAL DIRECTOR)
(401) 331-5320
Entity
Organization
Contact information
Practice address
100 HIGHLAND AVE STE 307, PROVIDENCE, RI 02906-2753
(401) 331-5320
(401) 331-6168
Mailing address
100 HIGHLAND AVE STE 307, PROVIDENCE, RI 02906-2753
(401) 331-5320
(401) 331-6168
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
RI3593
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2059883
AETNA
RI
01
—
847-1
BLUE CROSS
RI
05
—
9000847
—
RI
Enumeration date
01/29/2007
Last updated
08/22/2020
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