Healthcare Provider Details

I. General information

NPI: 1134195043
Provider Name (Legal Business Name): ANTHONY M REGINATO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 10/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 WAMPANOAG TRAIL SUITE 202B
E. PROVIDENCE RI
02915
US

IV. Provider business mailing address

375 WAMPANOAG TRAIL SUITE 202B
E. PROVIDENCE RI
02915
US

V. Phone/Fax

Practice location:
  • Phone: 401-649-4040
  • Fax: 401-649-4041
Mailing address:
  • Phone: 401-649-4040
  • Fax: 401-649-4041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number158176
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: