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

Table of content: KARL KURT STRANBERG JR. OT (NPI 1306139779)

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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