Healthcare Provider Details

I. General information

NPI: 1144303744
Provider Name (Legal Business Name): WICKFORD INTERNISTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 PHILLIPS ST SUITE 201
NORTH KINGSTOWN RI
02852-5149
US

IV. Provider business mailing address

320 PHILLIPS ST SUITE 201
NORTH KINGSTOWN RI
02852-5149
US

V. Phone/Fax

Practice location:
  • Phone: 401-295-3120
  • Fax: 401-295-1230
Mailing address:
  • Phone: 401-295-3120
  • Fax: 401-295-1230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number109903
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number109903
License Number StateRI

VIII. Authorized Official

Name: ROBERT A CAPALBO
Title or Position: PRESIDENT
Credential: MD
Phone: 401-295-3120