Active NPI
Daniel H. Lederer, MD
- Internal Medicine Physician
- Providence, RI
National Provider Identifier
1912911769
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- MD04938
- Practice address
- 345 Blackstone Blvd
Providence, RI 02906-4800 - Phone
- (401) 455-6200
- Fax
- (401) 455-6309
- NPI assigned
- Jul 28, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MD04938 | RI | Primary |
| Pulmonary Disease Physician | 207RP1001X | MD04938 | RI |
Addresses
Primary practice location
345 Blackstone Blvd
Providence, RI 02906-4800
Mailing address
345 Blackstone Blvd
Providence, RI 02906-4800
Phone (401) 455-6200
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0000021016 | Other | RI | BLUE SHIELD OF RHODE ISLAND |
| 0402683 | Other | RI | UNITED HEALTHCARE |
| 119021016 | Other | RI | MEDICARE OF RHODE ISLAND |
| 001290 | Other | RI | BLUE CHIP |
| 406113 | Other | RI | TUFTS HEALTH PLAN |
| 7003866 | Other | RI | MEDICAID OF RHODE ISLAND |
| 110206706 | Other | RI | RAILROAD MEDICARE |
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 |
|---|---|---|---|
| MD04938 | RI | MD | Pulmonary Disease Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209945600000",
"number": "1912911769",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "345 BLACKSTONE BLVD",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029064800",
"telephone_number": "401-455-6200",
"fax_number": "401-455-6309"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "345 BLACKSTONE BLVD",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029064800",
"telephone_number": "401-455-6200",
"fax_number": "401-455-6309"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEDERER",
"first_name": "DANIEL",
"middle_name": "H.",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-28",
"last_updated": "2008-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "RI",
"license": "MD04938",
"primary": true
},
{
"code": "207RP1001X",
"taxonomy_group": "",
"desc": "Internal Medicine, Pulmonary Disease",
"state": "RI",
"license": "MD04938",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD OF RHODE ISLAND",
"identifier": "0000021016",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "0402683",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE OF RHODE ISLAND",
"identifier": "119021016",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CHIP",
"identifier": "001290",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS HEALTH PLAN",
"identifier": "406113",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAID OF RHODE ISLAND",
"identifier": "7003866",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "110206706",
"state": "RI"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Providence, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.