Healthcare Provider Details

I. General information

NPI: 1649620683
Provider Name (Legal Business Name): ROBERT J FRUGGIERO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 04/21/2020
Certification Date: 04/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 PRESIDENT AVE STE 1004
FALL RIVER MA
02720-5923
US

IV. Provider business mailing address

200 MILL RD STE 180
FAIRHAVEN MA
02719-5255
US

V. Phone/Fax

Practice location:
  • Phone: 508-973-9600
  • Fax: 508-973-9605
Mailing address:
  • Phone: 508-973-2000
  • Fax: 508-973-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number279508
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: