Organization
LIFESPAN PHYSICIAN GROUP, INC.
Active
Other names
Metacom Medical
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PETER K MARKELL (EVP & CFO)
(401) 444-7914
Entity
Organization
Contact information
Practice address
639 METACOM AVE, WARREN, RI 02885-2348
(401) 245-1500
(401) 247-2618
Mailing address
117 ELLENFIELD ST, SUITE 101, PROVIDENCE, RI 02905-4513
(401) 444-6779
(401) 444-6912
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
10/08/2015
Last updated
04/20/2023
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