| Doctor Name: | DR. KEIVAN ETTEFAGH |
| NPI Number: | 1144227729 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | MD07109 |
| Business Practice Address: | 17 Virginia Ave Suite 107 Providence, RI - 029054406 |
| Business Phone Number: | 4014434990 |
| Business Fax Number: | 4017844902 |
| Mailing Address: | 50 Memorial Blvd, Aquidneck Medical Associates, Inc NEWPORT |
| State: | RI |
| Postal Code: | 028403587 |
| Phone Number: | 4018472290 |
| Fax Number: | 4018498446 |
| NPI Enumeration Date: | 06/28/2005 |
| NPI Last Update Date: | 06/13/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208000000X |
| License Number: | MD07109 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | RI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Pediatrics |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |