Healthcare Provider Details

I. General information

NPI: 1184609422
Provider Name (Legal Business Name): PATRICIA MARIA RUSSO-MAGNO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2090 WALLUM LAKE RD
PASCOAG RI
02859-1813
US

IV. Provider business mailing address

2090 WALLUM LAKE RD
PASCOAG RI
02859-1813
US

V. Phone/Fax

Practice location:
  • Phone: 401-567-5400
  • Fax:
Mailing address:
  • Phone: 401-729-2890
  • Fax: 401-729-3594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD10353
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD10353
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: