Active NPI
Marvin S Wasser, M.D.
- Pediatrics Physician
- Cranston, RI
National Provider Identifier
1629055827
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 5457
- Practice address
- 496 Pontiac Ave
Cranston, RI 02910-3520 - Phone
- (401) 461-2150
- NPI assigned
- Dec 28, 2005
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 5457 | RI | Primary |
Addresses
Primary practice location
496 Pontiac Ave
Cranston, RI 02910-3520
Mailing address
12 Eden Crest Dr
Cranston, RI 02920-8104
Phone (401) 944-5798
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C 89710 | Medicaid | RI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5457 | RI | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135728000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1629055827",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12 EDEN CREST DR",
"city": "CRANSTON",
"state": "RI",
"postal_code": "029208104",
"telephone_number": "401-944-5798"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "496 PONTIAC AVE",
"city": "CRANSTON",
"state": "RI",
"postal_code": "029103520",
"telephone_number": "401-461-2150"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WASSER",
"first_name": "MARVIN",
"middle_name": "S",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-12-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "RI",
"license": "5457",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "C 89710",
"state": "RI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cranston, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.