MEDICARE: NORTH PROVIDENCE PRIMARY CARE ASSOC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	RI 8466	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0406635	OTHER	RI	UNITED
2	232780	OTHER	RI	BC BS

General Provider Information

NPI Number	:	1902886757
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH PROVIDENCE PRIMARY CARE ASSOC INC

Provider Business Mailing Address
First Line	:	1830 MINERAL SPRING AVE
Second Line	:
City	:	NORTH PROVIDENCE
State	:	RI
Zip	:	02904-3864
Country	:	US
Telephone Number	:	401-351-1900
Fax Number	:	401-270-3080

Provider Business Practice Location Address
First Line	:	1830 MINERAL SPRING AVE
Second Line	:
City	:	NORTH PROVIDENCE
State	:	RI
Zip	:	02904-3864
Country	:	US
Telephone Number	:	401-351-1900
Fax Number	:	401-270-3080

Authorized Official
Title or Position	:	OWNER
Name	:	ANTHONY G FARINA JR.
Credential	:	MD
Telephone Number	:	401-351-1900

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	02/03/2014

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