1245439561 NPI number — DONALD V. FARGNOLI, M.D., INC.

Table of content: (NPI 1245439561)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245439561 NPI number — DONALD V. FARGNOLI, M.D., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DONALD V. FARGNOLI, M.D., INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1245439561
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1358 SMITH ST
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:
02911-3304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-353-2525
Provider Business Mailing Address Fax Number:
401-353-6792

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1358 SMITH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02911-3304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-353-2525
Provider Business Practice Location Address Fax Number:
401-353-6792
Provider Enumeration Date:
07/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FARGNOLI
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
VINCENT
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
401-353-2525

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  5736 , 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)

  • Identifier: 000762 . This is a "HMO BLUE CHIP NEW ENGLAND" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 2879 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 9000077 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0279 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 000762 . This is a "BLUE CHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 0000000077 . This is a "BLUE SHIELD OF RHODE ISLA" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 000762 . This is a "BLUE CHIP FOR MEDICARE OP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 180002352 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 728575 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 0800081 . This is a "UNITED HEALTHCARE (INDIVI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 000762 . This is a "BLUE CHIP FOR MEDICARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 189000077 . This is a "MEDICARE OF RHODE ISLAND" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 000762 . This is a "BLUE CHIP FOR RITECARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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