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General NPI Number Information
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NPI Number | 1497885719
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Entity Type | Organization
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Legal Business Name | LOUIS A FRAGOLA JR MD LTD
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1525 WAMPANOAG TRAIL
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City | EAST PROVIDENCE
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State | RI
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Zip | 02915
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Country | US
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Telephone | 401-433-4851
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Fax | 401-433-3650
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Provider Business Mailing Address
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Address Line | 1525 WAMPANOAG TRAIL
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City | EAST PROVIDENCE
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State | RI
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Zip | 02915
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Country | US
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Telephone | 401-433-4851
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Fax | 401-433-3650
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LOUIS A FRAGOLA JR.
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Credential | MD
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Telephone | 401-433-4851
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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 | RI4166
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License Number State | RI
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