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General NPI Number Information
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NPI Number | 1871304337
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Entity Type | Organization
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Legal Business Name | AGAPE DERAMTOLOGY OF JOHNSTON LLC
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Dates
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Enumeration Date | 01/15/2025
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 1526 ATWOOD AVE STE 210
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City | JOHNSTON
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State | RI
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Zip | 02919-3289
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Country | US
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Telephone | 401-396-2227
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Fax | 401-421-1120
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Provider Business Mailing Address
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Address Line | 1526 ATWOOD AVE STE 210
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City | JOHNSTON
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State | RI
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Zip | 02919-3289
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Country | US
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Telephone | 401-737-7546
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. PAUL MALLARI
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Credential | PA-C
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Telephone | 401-529-7787
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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 |
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License Number State |
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