1346228988 NPI number — RICHARD P SAN ANTONIO MD

Table of content: RICHARD P SAN ANTONIO MD (NPI 1346228988)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346228988 NPI number — RICHARD P SAN ANTONIO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAN ANTONIO
Provider First Name:
RICHARD
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1346228988
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
215 TOLL GATE RD
Provider Second Line Business Mailing Address:
SUITE 305
Provider Business Mailing Address City Name:
WARWICK
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02886-4458
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-738-2601
Provider Business Mailing Address Fax Number:
401-738-2660

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 TOLL GATE RD
Provider Second Line Business Practice Location Address:
SUITE 305
Provider Business Practice Location Address City Name:
WARWICK
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02886-4458
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-738-2601
Provider Business Practice Location Address Fax Number:
401-738-2660
Provider Enumeration Date:
01/04/2006

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: 207RC0000X , with the licence number:  6410 , 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: 006410 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9000485 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: AA39929 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 050415620 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2500217 . This is a "UNITED HEALTH" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 0005592221 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000485 . This is a "BLUE CROSS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: P12043590 . This is a "MULTI PLAN" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com