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General NPI Number Information
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NPI Number | 1548461544
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Entity Type | Individual
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Provider Name | AUGUSTINE ALBERT MANOCCHIA M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 655 BROAD ST
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City | PROVIDENCE
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State | RI
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Zip | 02907-1444
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Country | US
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Telephone | 401-274-6347
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Fax |
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Provider Business Mailing Address
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Address Line | 12 CASANDRA LN
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City | NORTH KINGSTOWN
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State | RI
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Zip | 02852-3410
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Country | US
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Telephone | 401-528-7634
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Fax | 401-459-5599
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD7311
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License Number State | RI
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