DR. LEE EVERETT EDSTROM


Address: 2 Dudley, Suite 460, Providence, RI 02905
Phone: 4013312303

DR. LEE EVERETT EDSTROM (NPI# 1669566303) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1669566303
Entity Type Individual
Full Name DR. LEE EVERETT EDSTROM
Credential M.D.
Practice Address 2 Dudley
Suite 460
Providence
RI 02905
Practice Telephone 4013312303
Practice Fax Number 4013314430
Mailing Telephone 4013312303
Mailing Fax Number 4013314430
Enumeration Date 2006-10-03
Last Update Date 2007-07-08
Gender Code M
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 208200000X Plastic Surgery 5949 RI Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
RI UNITED HEALTH 1300121 01
RI DEA# RI5949 01
RI TAX ID 050395339 01
RI BLUECHIP 300043 01

Office Location

Street Address 2 DUDLEY
SUITE 460
City PROVIDENCE
State RI
Zip Code 02905

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1477100808 Raisa Emilia Garcia-diaz Counselor 66 Pavilion Avenue, Providence, RI 02905 2019-08-21
1962976571 Nike A. Kendall Social Worker Program In Women's Oncology, 101 Dudley Street, Providence, RI 02905 2019-01-16
1891265443 Carolyn Te Young Pathology 1320 Narragansett Blvd, Cranston, RI 02905 2018-11-27
1417427071 Julianne Elizabeth Houtchens Dietitian, Registered Adult Primary Care 245 Chapman Street, Providence, RI 02905 2018-11-27
1922577394 Dilenia C Cruz Health Educator 335r Prairie Ave., Suite 2b, Providence, RI 02905 2018-11-15
1639653116 Varina S. Gunn Health Educator 335r Prarie Ave., Suite 2b, Providence, RI 02905 2018-09-20
1427590421 Cardea Healthcare LLC In Home Supportive Care 100 Pavilion Avenue, Suite 101, Providence, RI 02905 2016-11-08
1265884597 Maxwell King Physical Therapy Assistant 48 Moorland Avenue, Cranston, RI 02905 2016-07-11
1346698024 Samantha Lea Colli Physician Assistant 100 Dudley St Fl 3, Providence, RI 02905 2016-06-02
1346697448 Amy Jean Simpson Marriage & Family Therapist 1981 Broad Street, Cranston, RI 02905 2016-05-18
Find all providers in zip 02905

Taxonomy Information

Taxonomy Code 208200000X
Grouping Allopathic & Osteopathic Physicians
Classification Plastic Surgery

Taxonomy Definition

A plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk and external genitalia or cosmetic enhancement of these areas of the body. Cosmetic surgery is an essential component of plastic surgery. The plastic surgeon uses cosmetic surgical principles to both improve overall appearance and to optimize the outcome of reconstructive procedures. The surgeon uses aesthetic surgical principles not only to improve undesirable qualities of normal structures but in all reconstructive procedures as well.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Plastic Surgery, 2007. http://www.abplsurg.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Plastic Surgery.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1144309006 Helena Olga Beatrice Taylor Plastic Surgery 2 Dudley St Ste 180, Providence, RI 02905-3248 2006-11-03
1871581389 David T. Barrall Plastic Surgery 151 Waterman St, Providence, RI 02906-2118 2005-10-10
1184623282 James Weintrub Plastic Surgery 34 Barnes St, Providence, RI 02906-1502 2005-07-20
1649894924 Mimi Rosealie Borrelli Plastic Surgery 593 Eddy St, Providence, RI 02903-4923 2020-06-03
1245897925 Solomon Swartz Plastic Surgery 593 Eddy St, Providence, RI 02903-4923 2019-05-28
1033776349 Damon Mcintire Plastic Surgery 593 Eddy St, Providence, RI 02903-4923 2019-05-22
1467982082 Dardan Beqiri Plastic Surgery 593 Eddy Street, Providence, RI 02903 2017-06-15
1700315009 Vinay Rao Plastic Surgery 593 Eddy St, Providence, RI 02903-4923 2017-06-08
1932557303 William Snapp Plastic Surgery 593 Eddy St, Providence, RI 02903-4923 2016-05-26
1497102487 Lauren Roussel Plastic Surgery 593 Eddy St, Providence, RI 02903-4923 2016-05-19
Find all providers in PROVIDENCE

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City PROVIDENCE
Zip Code 02905

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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