Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Jack R Bevivino, MD

Individual provider Plastic Surgery Physician · NPI 1780705707

Jack R Bevivino, MD is a Plastic Surgery Physician in Providence, Rhode Island. Licensed in Rhode Island. Registered with an NPI since 2007.

Licensed in
RI
In the registry since
2007
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

120 Dudley St Ste #201
Providence, RI 02905-2431
Phone: (401) 521-9290
Fax: (401) 521-9297
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Plastic Surgery Physician (primary) Taxonomy 208200000X · Licence RIMD05259 (RI)

Record details

NPI number1780705707
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedApril 3, 2007
Last updated in NPPESJuly 8, 2007
Mailing address120 Dudley Street, Suite #201, Providence, RI 02905-2431

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