Individual provider Active NPI

Daniel H. Lederer, MD

  • Internal Medicine Physician
  • Providence, RI
National Provider Identifier
1912911769
Registry record updated May 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD04938 Issued in RI
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

Updated by the provider on May 5, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
0000021016OtherRIBLUE SHIELD OF RHODE ISLAND
0402683OtherRIUNITED HEALTHCARE
119021016OtherRIMEDICARE OF RHODE ISLAND
001290OtherRIBLUE CHIP
406113OtherRITUFTS HEALTH PLAN
7003866OtherRIMEDICAID OF RHODE ISLAND
110206706OtherRIRAILROAD 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

LicenseStateTypeSpecialty
MD04938RIMDPulmonary 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.

Verify at the official NPI Registry.