1235100280 NPI number — ANNA MARIE FLAHERTY FNP

Table of content: (NPI 1164891511)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235100280 NPI number — ANNA MARIE FLAHERTY FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLAHERTY
Provider First Name:
ANNA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235100280
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 PINEWOOD DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02904-3413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-559-7384
Provider Business Mailing Address Fax Number:
401-823-9180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ALEXANDER SCAGNELLI, MD, PC
Provider Second Line Business Practice Location Address:
469 CENTERVILLE RD. SUITE 103
Provider Business Practice Location Address City Name:
WARWICK
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02886-4335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-821-4100
Provider Business Practice Location Address Fax Number:
401-823-9180
Provider Enumeration Date:
01/29/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  NPP 19663 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: APRN00248 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)