NPIMap

Organization Active NPI

John Jefferys Bandola, M.D.

  • Internal Medicine Physician
  • Wakefield, RI
National Provider Identifier
1629265236
Registry record updated Mar 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
5619 Issued in RI
Legal business name
JOHN JEFFERYS BANDOLA, M.D.
Practice address
70 Kenyon Ave
Suite 326
Wakefield, RI 02879-4239
Phone
(401) 789-8543
Fax
(401) 782-8766
NPI assigned
Sep 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. John Jefferys Bandola, M.D.
Title
Owner
Phone
(401) 789-8543

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 5619 RI Primary

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

National Provider Directory

National Provider Directory

Locations

70 Kenyon Ave
Ste 26
Wakefield, RI 02879
Phone (401) 789-8543

70 Kenyon Ave
Ste 326
Wakefield, RI 02879
Phone (401) 788-1277

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1269302400000",
    "number": "1629265236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "70 KENYON AVE",
            "address_2": "SUITE 326",
            "city": "WAKEFIELD",
            "state": "RI",
            "postal_code": "028794239",
            "telephone_number": "401-789-8543",
            "fax_number": "401-782-8766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70 KENYON AVE",
            "address_2": "SUITE 326",
            "city": "WAKEFIELD",
            "state": "RI",
            "postal_code": "028794239",
            "telephone_number": "401-789-8543",
            "fax_number": "401-782-8766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN JEFFERYS BANDOLA, M.D.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-27",
        "last_updated": "2010-03-23",
        "status": "A",
        "authorized_official_last_name": "BANDOLA",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "JEFFERYS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "401-789-8543",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "RI",
            "license": "5619",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wakefield, RI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.