Basic Information
| Provider Information | |||||||||
| NPI: | 1912992645 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MIGLIORI | ||||||||
| FirstName: | SIDNEY | ||||||||
| MiddleName: | PREMER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 725 RESERVOIR AVE | ||||||||
| Address2: | NUMBER 101 | ||||||||
| City: | CRANSTON | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029104448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4019443800 | ||||||||
| FaxNumber: | 4019441342 | ||||||||
| Practice Location | |||||||||
| Address1: | 725 RESERVOIR AVE | ||||||||
| Address2: | NUMBER 101 | ||||||||
| City: | CRANSTON | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029104448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4019443800 | ||||||||
| FaxNumber: | 4019441342 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2005 | ||||||||
| LastUpdateDate: | 08/18/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | MD09084 | RI | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 7008852 | 05 | RI | MEDICAID | 32298-0 | 01 | RI | RI BLUE CROSS | OTHER | 1912992645 | 01 | RI | DURABLE | OTHER | 400484 | 01 | RI | CHIP | OTHER |