Healthcare Provider Details

I. General information

NPI: 1699715920
Provider Name (Legal Business Name): CHRISTOPHER W DIGIOVANNI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 02/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BUTLER DR
PROVIDENCE RI
02906-4862
US

IV. Provider business mailing address

2 DUDLEY ST
PROVIDENCE RI
02905-3236
US

V. Phone/Fax

Practice location:
  • Phone: 401-330-1430
  • Fax:
Mailing address:
  • Phone: 401-330-1430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number09152
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number091520
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: