Lifespan Physician Group, Inc.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

LIFESPAN PHYSICIAN GROUP, INC.

Practice address

639 Metacom Ave
Warren, RI 02885-2348

Phone

(401) 245-1500

Fax

(401) 247-2618

NPI assigned

Oct 8, 2015

Last updated

Apr 20, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Peter K Markell

Title

Evp & Cfo

Phone

(401) 444-7914

Specialties & licenses 3

Addresses

Other names 1

• Metacom Medical Other name

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

{
    "created_epoch": "1444262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681948800000",
    "number": "1629449210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 ELLENFIELD ST",
            "address_2": "SUITE 101",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029054513",
            "telephone_number": "401-444-6779",
            "fax_number": "401-444-6912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "639 METACOM AVE",
            "city": "WARREN",
            "state": "RI",
            "postal_code": "028852348",
            "telephone_number": "401-245-1500",
            "fax_number": "401-247-2618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESPAN PHYSICIAN GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-08",
        "last_updated": "2023-04-20",
        "certification_date": "2023-04-20",
        "status": "A",
        "authorized_official_last_name": "MARKELL",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "EVP & CFO",
        "authorized_official_telephone_number": "401-444-7914",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Metacom Medical",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Metacom Medical",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kintsugi Center for Healing and Wholeness, LLC
• Nicole Kluge, BCBA
• Alec Kotkowski, MA,BCBA
• Rachel Leese, PHARMD
• Peter N Lemieux
• Paul Thomas Marcaccio, MD
• Kiera Marchesi
• Marilyn J Martin, RN
• Maureen McDonnell
• William S. McGurk, PH.D.

• Internal Medicine Physician in Warren, RI
• Providers in Warren, RI by specialty
• Internal Medicine Physician in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2023; 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.