Healthcare Provider Details

I. General information

NPI: 1487651618
Provider Name (Legal Business Name): JANE G MINIUTTI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 MAIN RD
TIVERTON RI
02878-4625
US

IV. Provider business mailing address

200 MILL RD STE 180
FAIRHAVEN MA
02719-5252
US

V. Phone/Fax

Practice location:
  • Phone: 401-625-5552
  • Fax: 401-625-5277
Mailing address:
  • Phone: 508-973-2000
  • Fax: 508-973-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO00436
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: