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General NPI Number Information
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NPI Number | 1760448930
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Entity Type | Individual
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Provider Name | ROGER F FAZIO M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/25/2006
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Last Update Date | 07/25/2025
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Provider Practice Location Address
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Address Line | 49 S COUNTY COMMONS WAY UNIT F5
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City | WAKEFIELD
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State | RI
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Zip | 02879-8200
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Country | US
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Telephone | 401-783-8008
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Fax | 401-783-8156
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Provider Business Mailing Address
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Address Line | 49 S COUNTY COMMONS WAY UNIT F5
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City | WAKEFIELD
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State | RI
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Zip | 02879-8200
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Country | US
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Telephone | 401-783-8008
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Fax | 401-783-8156
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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 | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | MD11861
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License Number State | RI
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