Healthcare Provider Details

I. General information

NPI: 1396806352
Provider Name (Legal Business Name): MICHAEL M PALATUCCI PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1637 MINERAL SPRING AVE SUITE 215
NORTH PROVIDENCE RI
02904-4055
US

IV. Provider business mailing address

1637 MINERAL SPRING AVE SUITE 215
NORTH PROVIDENCE RI
02904-4055
US

V. Phone/Fax

Practice location:
  • Phone: 401-353-7330
  • Fax: 401-354-4760
Mailing address:
  • Phone: 401-353-7330
  • Fax: 401-354-4760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00260
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberPA00260
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: