=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245439561
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DONALD V. FARGNOLI, M.D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2007
-----------------------------------------------------
Last Update Date | 06/05/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1358 SMITH ST
-----------------------------------------------------
City | NORTH PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02911-3304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-353-2525
-----------------------------------------------------
Fax | 401-353-6792
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1358 SMITH ST
-----------------------------------------------------
City | NORTH PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02911-3304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-353-2525
-----------------------------------------------------
Fax | 401-353-6792
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DONALD VINCENT FARGNOLI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 401-353-2525
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 5736
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------