Healthcare Provider Details

I. General information

NPI: 1710172283
Provider Name (Legal Business Name): IWONA PAOLUCCI MD LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2007
Last Update Date: 03/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 TOLL GATE RD #209
WARWICK RI
02886-4458
US

IV. Provider business mailing address

215 TOLL GATE RD #209
WARWICK RI
02886-4458
US

V. Phone/Fax

Practice location:
  • Phone: 401-825-8200
  • Fax:
Mailing address:
  • Phone: 401-825-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD11590
License Number StateRI

VIII. Authorized Official

Name: IWONA PAOLUCCI
Title or Position: OWNER
Credential: MD
Phone: 401-725-8200