MEDICARE: JANE G MINIUTTI DO

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	207Q00000X	Family Medicine Physician	DO00436	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

General Provider Information

NPI Number	:	1487651618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE G MINIUTTI DO

Provider Business Mailing Address
First Line	:	200 MILL RD
Second Line	:	STE 180
City	:	FAIRHAVEN
State	:	MA
Zip	:	02719-5252
Country	:	US
Telephone Number	:	508-973-2000
Fax Number	:	508-973-2001

Provider Business Practice Location Address
First Line	:	1800 MAIN RD
Second Line	:
City	:	TIVERTON
State	:	RI
Zip	:	02878-4625
Country	:	US
Telephone Number	:	401-625-5552
Fax Number	:	401-625-5277

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	04/23/2020

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