Healthcare Provider Details

I. General information

NPI: 1902886757
Provider Name (Legal Business Name): NORTH PROVIDENCE PRIMARY CARE ASSOC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 02/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 MINERAL SPRING AVE
NORTH PROVIDENCE RI
02904-3864
US

IV. Provider business mailing address

1830 MINERAL SPRING AVE
NORTH PROVIDENCE RI
02904-3864
US

V. Phone/Fax

Practice location:
  • Phone: 401-351-1900
  • Fax: 401-270-3080
Mailing address:
  • Phone: 401-351-1900
  • Fax: 401-270-3080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberRI 8466
License Number StateRI

VIII. Authorized Official

Name: ANTHONY G FARINA JR.
Title or Position: OWNER
Credential: MD
Phone: 401-351-1900