Healthcare Provider Details

I. General information

NPI: 1669576062
Provider Name (Legal Business Name): FORTUNATO PROCOPIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: FRED PROCOPIO M.D.

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 BUTTERFIELD RD POTTER BLDG
KINGSTON RI
02881
US

IV. Provider business mailing address

44 HICKORY DR
EAST GREENWICH RI
02818-2516
US

V. Phone/Fax

Practice location:
  • Phone: 401-874-2246
  • Fax: 401-874-2586
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number7228
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: