Provider Demographics
NPI:1174514210
Name:DEBLASIO, PETER F JR (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:F
Last Name:DEBLASIO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1532 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02911-2939
Mailing Address - Country:US
Mailing Address - Phone:401-353-5735
Mailing Address - Fax:401-353-1020
Practice Address - Street 1:1532 SMITH ST
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02911-2939
Practice Address - Country:US
Practice Address - Phone:401-353-5735
Practice Address - Fax:401-353-1020
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI5407207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7001864Medicaid
RI180000314OtherRAILROAD MEDICARE
RI189001022Medicare PIN
RI180000314OtherRAILROAD MEDICARE
RI7001864Medicaid