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General NPI Number Information
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NPI Number | 1235305871
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Entity Type | Organization
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Legal Business Name | AGAPE PRIMARY CARE AND LASER CENTER LLC
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Dates
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Enumeration Date | 05/04/2008
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Last Update Date | 06/03/2008
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Provider Practice Location Address
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Address Line | 1195 N MAIN ST
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City | PROVIDENCE
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State | RI
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Zip | 02904-1824
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Country | US
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Telephone | 401-654-4433
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Fax |
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Provider Business Mailing Address
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Address Line | 1195 N MAIN ST
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City | PROVIDENCE
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State | RI
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Zip | 02904-1824
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Country | US
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Telephone | 401-654-4433
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | FRANK MICHAEL D'ALESSANDRO
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Credential | M.D.
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Telephone | 401-654-4433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | MD10894
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD08003
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License Number State | RI
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