Lee E Edstrom (NPI# 1669566303, PAC ID# 1759442536) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PLASTIC AND RECONSTRUCTIVE SURGERY.
| Nation Provider ID (NPI) | 1669566303 |
| PAC ID by PECOS | 1759442536 |
| Professional Enrollment ID | I20081211000701 |
| Full Name | Lee E Edstrom |
| Organization Legal Name | LIFESPAN PHYSICIAN GROUP, INC. |
| Address |
2 Dudley St Providence RI 02905-3252 |
| Phone Number | 4014534500 |
| Gender | M |
| Medical School | CASE WESTERN RESERVE UNIVERSITY SCHOOL OF MEDICINE |
| Graduation Year | 1969 |
| Primary Specialty | PLASTIC AND RECONSTRUCTIVE SURGERY |
| Group Practice PAC ID | 2567455082 |
| Number of Group Practice Members | 536 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 410007 | RHODE ISLAND HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 950 Warren Ave, Suite 103, East Providence, RI 02914-1414 | 4016064325 | RHODE ISLAND HOSPITAL |
| 950 Warren Ave, East Providence, RI 02914-1414 | 4016064325 | RHODE ISLAND HOSPITAL |
| 2 Dudley St, Providence, RI 02905-3252 | 4014534500 | LIFESPAN PHYSICIAN GROUP, INC. |
| Organization Legal Name | LIFESPAN PHYSICIAN GROUP, INC. |
| Physicians | 75 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Carl E Levick | Cardiovascular Disease (cardiology) | Lifespan Physician Group, Inc. | 6 Blackstone Plaza, Valley Place, Lincoln, RI 02865 |
| John A Day Jr. | Pulmonary Disease | Lifespan Physician Group, Inc. | 19 Friendship, Providence, RI 02903-3913 |
| Terri L Chalker | Certified Registered Nurse Anesthetist | Lifespan Physician Group, Inc. | 593 Eddy St, Providence, RI 02903-4923 |
| Adriana M Hosu | Internal Medicine | Lifespan Physician Group, Inc. | 593 Eddy St Apc, Suite 6, Providence, RI 02903-4923 |
| Andrea C Sartori | Clinical Psychologist | Lifespan Physician Group, Inc. | 593 Eddy St, Providence, RI 02903-4923 |
| Damien Paul Hebert | Certified Registered Nurse Anesthetist | Lifespan Physician Group, Inc. | 17 Seekonk St, Providence, RI 02906-5125 |
| Rebecca Leigh Jackson | Nurse Practitioner | Lifespan Physician Group, Inc. | 185 High Service Ave, North Providence, RI 02904-5114 |
| Jennifer T Dibello | Registered Dietitian Or Nutrition Professional | Lifespan Physician Group, Inc. | 148 W River St, Suite 1g, Providence, RI 02904-2615 |
| Kristin Beauregard | Nurse Practitioner | Lifespan Physician Group, Inc. | 593 Eddy St Apc, Suite 6, Providence, RI 02903-4923 |
| Lynn C Schultz | Certified Registered Nurse Anesthetist | Lifespan Physician Group, Inc. | 593 Eddy St, Providence, RI 02903-4923 |
| Street Address |
2 DUDLEY ST |
| City | PROVIDENCE |
| State | RI |
| Zip | 02905-3252 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Brad Douglas Blankenhorn | Orthopedic Surgery | University Orthopedics, Inc. | 2 Dudley St, Suite 200, Providence, RI 02905-3248 |
| Lars Stangenberg | Vascular Surgery | University Surgical Associates, Inc. | 2 Dudley St, Suite 470, Providence, RI 02905-3248 |
| Todd Stafford | General Surgery | University Surgical Associates, Inc. | 2 Dudley St, Suite 190, Providence, RI 02905-3248 |
| Phillip Lucas | Orthopedic Surgery | University Orthopedics, Inc. | 2 Dudley St, Suite 200, Providence, RI 02905-3248 |
| Amy P Pilotte | Nurse Practitioner | University Surgical Associates, Inc. | 2 Dudley St, Suite 470, Providence, RI 02905-3248 |
| Philip Haines | Cardiovascular Disease (cardiology) | Lifespan Physician Group Inc | 2 Dudley St, Providence, RI 02905-3236 |
| Jaclyn Plante | Physical Therapy | University Orthopedics, Inc. | 2 Dudley St, Suite 200, Providence, RI 02905-3248 |
| Stephanie N Lueckel | General Surgery | University Surgical Associates, Inc. | 2 Dudley St, Suite 190, Providence, RI 02905-3248 |
| Eric Benoit | General Surgery | University Surgical Associates, Inc. | 2 Dudley St, Suite 190, Providence, RI 02905-3248 |
| Nikola Babovic | Orthopedic Surgery | University Orthopedics, Inc. | 2 Dudley St, Suite 200, Providence, RI 02905-3248 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Clarissa D. Lewis | Optometry | The Providence Community Health Centers Inc. | 335 Prairie Ave, Fl 2, Providence, RI 02905-1924 |
| Angel M. Eads | Family Medicine | The Providence Community Health Centers Inc. | 355 Prairie Ave, Providence, RI 02905-1928 |
| Sandrine O Guilherme | Clinical Social Worker | The Providence Center Inc | 355 Prairie Ave, Providence, RI 02905-1928 |
| Katherine Williams | Family Medicine | The Providence Community Health Centers Inc. | 355 Prairie Ave, Providence, RI 02905-1928 |
| Luis A Ferreira | Clinical Social Worker | The Providence Center Inc | 355 Prairie Ave, Providence, RI 02905-1928 |
| Andrew Saal | Family Medicine | The Providence Community Health Centers Inc. | 355 Prairie Ave, Providence, RI 02905-1928 |
| Lauren E Stewart | Obstetrics/gynecology | The Providence Community Health Centers Inc. | 355 Prairie Ave, Providence, RI 02905-1928 |
| Tenesha R Lisbon | Nurse Practitioner | The Providence Community Health Centers Inc. | 355 Prairie Ave, Providence, RI 02905-1928 |
| Elaine K Parker Williams | Nurse Practitioner | The Providence Community Health Centers Inc. | 355 Prairie Ave, Providence, RI 02905-1928 |
| Carla Martin | Internal Medicine | The Providence Community Health Centers Inc. | 355 Prairie Ave, Providence, RI 02905-1928 |
| Find all physicians in zip 02905 | |||
| City | PROVIDENCE |
| Zip Code | 02905 |
| Specialty | PLASTIC AND RECONSTRUCTIVE SURGERY |
| City + Specialty | PROVIDENCE + PLASTIC AND RECONSTRUCTIVE SURGERY |
Please comment or provide details below to improve the information on Lee E Edstrom.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.