NPI Code Detail JSON Logo

1871302141 NPI number — AGAPE DERMATOLOGY OF JOHNSTON LLC

NPI Number: 1871302141
Health Care Provider/Practitioner: AGAPE DERMATOLOGY OF JOHNSTON LLC

Information about “1871302141” NPI (AGAPE DERMATOLOGY OF JOHNSTON LLC) exists in 1871302141 in HTML format HTML  |  1871302141 in plain Text format TXT  |  1871302141 in PDF (Portable Document Format) PDF  |  1871302141 in an XML format XML  formats.

NPI Number : 1871302141 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1871302141",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "AGAPE DERMATOLOGY OF JOHNSTON LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1526 ATWOOD AVE STE 210",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "JOHNSTON",
    "MailingAddressStateName": "RI",
    "MailingAddressPostalCode": "02919-3289",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "401-737-7546",
    "MailingAddressFaxNumber": "401-384-6741",
    "FirstLinePracticeLocationAddress": "1526 ATWOOD AVE STE 220",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "JOHNSTON",
    "PracticeLocationAddressStateName": "RI",
    "PracticeLocationAddressPostalCode": "02919-3289",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "401-396-2227",
    "PracticeLocationAddressFaxNumber": "401-421-1120",
    "EnumerationDate": "01/02/2025",
    "LastUpdateDate": "01/02/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "MALLARI",
    "AuthorizedOfficialFirstName": "PAUL",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "PA-C",
    "AuthorizedOfficialTelephoneNumber": "401-737-7546",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207N00000X",
        "TaxonomyName": "Dermatology Physician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.