Healthcare Provider Details

I. General information

NPI: 1700953395
Provider Name (Legal Business Name): JOHN ANTHONY SANACORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 ATWOOD AVE SUITE 110
JOHNSTON RI
02919
US

IV. Provider business mailing address

1524 ATWOOD AVE SUITE 110
JOHNSTON RI
02919
US

V. Phone/Fax

Practice location:
  • Phone: 401-274-2910
  • Fax: 401-274-8907
Mailing address:
  • Phone: 401-274-2910
  • Fax: 401-274-8907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number7598
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: