| Name: | NARRAGANSETT BAY PEDIATRICS, INC. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Profit Corporation |
| Status: | Revoked Entity |
| Date of Organization in Rhode Island: | 15 Apr 1986 (39 years ago) |
| Date of Dissolution: | 09 Nov 2010 (14 years ago) |
| Date of Status Change: | 09 Nov 2010 (14 years ago) |
| Identification Number: | 000038258 |
| ZIP code: | 02879 |
| County: | Washington County |
| Principal Address: | 70 KENYON AVENUE, WAKEFIELD, RI, 02879, USA |
| Purpose: | PEDIATRIC OFFICE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1558403550 | 2007-02-13 | 2020-08-22 | 70 KENYON AVE, SUITE 101, WAKEFIELD, RI, 028794239, US | 70 KENYON AVE, SUITE 101, WAKEFIELD, RI, 028794239, US | |||||||||||||||||||||||||||||||||||||||
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| Phone | +1 401-789-5924 |
| Fax | 4017821770 |
Authorized person
| Name | DR. CELESTE C. CORCORAN |
| Role | PRESIDENT |
| Phone | 4017895924 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | NB04039 |
| State | RI |
| Issuer | NEIGHBORHOOD HEALTH PLAN |
| Number | 0668 |
| State | RI |
| Issuer | BLUE CROSS GROUP NUMBER |
| Number | 155-7 |
| State | RI |
| Issuer | BLUE CHIP GROUP NUMBER |
| Number | 201468 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| CELESTE C. CORCORAN, MD | Agent | 110 DAVID'S WAY, WAKEFIELD, RI, 02879, USA |
| Name | Role | Address |
|---|---|---|
| ROBERT D. MALTZ M.D. | SECRETARY | 70 KENYON AVE WAKEFIELD, RI 02879 |
| Name | Role | Address |
|---|---|---|
| CELESTE C CORCORAN MD | PRESIDENT | 70 KENYON AVENUE WAKEFIELD, RI 02879 USA |
| Name | Role | Address |
|---|---|---|
| MARY E. MURRAY | VICE PRESIDENT | 70 KENYON AVE. WAKEFIELD, RI 02879 USA |
| Number | Name | File Date |
|---|---|---|
| 201071997020 | Revocation Certificate For Failure to File the Annual Report for the Year | 2010-11-09 |
| 201063060590 | Revocation Notice For Failure to File An Annual Report | 2010-06-16 |
| 200943191230 | Annual Report | 2009-03-01 |
| 200807686960 | Annual Report | 2008-03-03 |
Date of last update: 06 Oct 2024
Sources: Rhode Island Department of State
