Provider Demographics
NPI:1861621294
Name:CHRISTOPHER W LEY MD, INC
Entity type:Organization
Organization Name:CHRISTOPHER W LEY MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:WALKER
Authorized Official - Last Name:LEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-572-3887
Mailing Address - Street 1:148 W RIVER ST
Mailing Address - Street 2:SUITE 22B
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-2615
Mailing Address - Country:US
Mailing Address - Phone:401-572-3887
Mailing Address - Fax:401-865-6192
Practice Address - Street 1:148 W RIVER ST
Practice Address - Street 2:SUITE 22B
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-2615
Practice Address - Country:US
Practice Address - Phone:401-572-3887
Practice Address - Fax:401-865-6192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-07
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD06618207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIMD06618OtherSTATE LICENSE
RI=========OtherTAX ID