John Jefferys Bandola, M.D.
Individual provider Active NPI Internal Medicine Physician · Wakefield, RI
NPI 1023129491 · NPPES record last updated Mar 18, 2010
Key facts
- NPI
- 1023129491
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- RI5619 (RI)
- Practice address
- 70 Kenyon Ave
Suite 326
Wakefield, RI 02879-4239 - Phone
- (401) 789-8543
- Fax
- (401) 782-8766
- NPI assigned
- Aug 31, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RI5619 | RI | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Seacoast Eye Associates Inc | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | RI5619 | RI | Yes |
Addresses
Primary practice location
70 Kenyon Ave
Suite 326
Wakefield, RI 02879-4239
Mailing address
70 Kenyon Ave
Suite 326
Wakefield, RI 02879-4239
Phone (401) 789-8543
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1D9000094 | Medicaid | RI | |
| 000196 | Other | RI | RHODE ISLAND BLUE CHIP |
| 0000000094 | Other | RI | RHODE ISLAND BLUE CROSS AND BLUE SHIELD |
Other providers in Wakefield, RI
- Adam Armisto
- Roger Ashley
- James William Assif
- Atlantic Professional Services of Rhode Island Incorporated
- Alexander Balkum
- Emma Joy Banks
- Amy Lee Barker
- Paul F Barratt
- Caroline W Barri
- Bashar Bash
All providers in Wakefield, RI · Internal Medicine Physician in Rhode Island
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 18, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.