Healthcare Provider Details

I. General information

NPI: 1417538109
Provider Name (Legal Business Name): NOAH VINCENZO LUPICA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 PROVIDENCE ST
WEST WARWICK RI
02893-2508
US

IV. Provider business mailing address

186 PROVIDENCE ST
WEST WARWICK RI
02893-2508
US

V. Phone/Fax

Practice location:
  • Phone: 401-767-4100
  • Fax:
Mailing address:
  • Phone: 401-767-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberCMD20062
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: