MEDICARE: WICKFORD INTERNISTS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	109903	RI
2	207Q00000X	Family Medicine Physician	109903	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144303744
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WICKFORD INTERNISTS, INC.

Provider Business Mailing Address
First Line	:	320 PHILLIPS ST
Second Line	:	SUITE 201
City	:	NORTH KINGSTOWN
State	:	RI
Zip	:	02852-5149
Country	:	US
Telephone Number	:	401-295-3120
Fax Number	:	401-295-1230

Provider Business Practice Location Address
First Line	:	320 PHILLIPS ST
Second Line	:	SUITE 201
City	:	NORTH KINGSTOWN
State	:	RI
Zip	:	02852-5149
Country	:	US
Telephone Number	:	401-295-3120
Fax Number	:	401-295-1230

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERT A CAPALBO
Credential	:	MD
Telephone Number	:	401-295-3120

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	09/11/2025

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Directions to “WICKFORD INTERNISTS, INC. ” Practice Location

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