Organization
CRANSTON PEDIATRICS LLC DBA PARK PEDIATRICS INC
Active
Other names
Park Pediatrics, Inc
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICK MANUEL QUILES M.D. (PRESIDENT)
(401) 274-6575
Entity
Organization
Contact information
Practice address
801 PARK AVE, CRANSTON, RI 02910-2036
(401) 274-6575
(401) 273-2597
Mailing address
801 PARK AVE, CRANSTON, RI 02910-2036
(401) 274-6575
(401) 273-2597
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD11641
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25-79403
UNITED HEALTH PLAN
RI
01
—
30943
NEIGHBORHOOD HEALTH PLAN
RI
01
—
31923-4
BLUE CROSS BLUE SHIELD
RI
01
—
412877
HEALTHMATE
RI
05
—
9004316
—
RI
01
—
MD 11641
LICENSE NUMBER
RI
Enumeration date
04/24/2007
Last updated
04/22/2008
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