Healthcare Provider Details

I. General information

NPI: 1760448930
Provider Name (Legal Business Name): ROGER F FAZIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 S COUNTY COMMONS WAY UNIT F5
WAKEFIELD RI
02879-8200
US

IV. Provider business mailing address

49 S COUNTY COMMONS WAY UNIT F5
WAKEFIELD RI
02879-8200
US

V. Phone/Fax

Practice location:
  • Phone: 401-783-8008
  • Fax: 401-783-8156
Mailing address:
  • Phone: 401-783-8008
  • Fax: 401-783-8156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberMD11861
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: