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General NPI Number Information
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NPI Number | 1396806352
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Entity Type | Individual
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Provider Name | MICHAEL M PALATUCCI PAC
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Gender | Male
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 1637 MINERAL SPRING AVE SUITE 215
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City | NORTH PROVIDENCE
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State | RI
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Zip | 02904-4055
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Country | US
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Telephone | 401-353-7330
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Fax | 401-354-4760
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Provider Business Mailing Address
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Address Line | 1637 MINERAL SPRING AVE SUITE 215
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City | NORTH PROVIDENCE
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State | RI
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Zip | 02904-4055
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Country | US
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Telephone | 401-353-7330
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Fax | 401-354-4760
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | PA00260
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA00260
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License Number State | RI
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