Individual
PETER THOMAS EVANGELISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
125 METRO CENTER BLVD STE 2000, WARWICK, RI 02886-1785
(401) 432-2520
(401) 453-8220
Mailing address
125 METRO CENTER BLVD STE 2000, WARWICK, RI 02886-1785
(401) 432-2520
(401) 453-8220
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
217024
MA
2085R0202X
Diagnostic Radiology Physician
Primary
MD11408
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003124047
CT MED ASSISTANCE
—
01
—
2081920
MASSMEDICAID
—
01
—
2465834
CIGNA
—
01
—
3707988
AETNA
—
01
—
411628
BLUECHIP
—
01
—
9003434
RIMEDICALASSISTANCE
—
01
—
9356928
PHHCS
—
01
—
AA16956
RIHPILGRIM
—
01
—
P00120864
RAILROAD MEDICARE
—
Enumeration date
10/13/2005
Last updated
04/02/2019
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