Provider Demographics
NPI:1073218673
Name:FRAGOSO DELGADO, LIGIA ELENA (MD)
Entity Type:Individual
Prefix:
First Name:LIGIA
Middle Name:ELENA
Last Name:FRAGOSO DELGADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LIGIA
Other - Middle Name:
Other - Last Name:FRAGOSO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LIGIA FRAGOSO
Mailing Address - Street 1:45 SYCAMORE ST APT A
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02909-1933
Mailing Address - Country:US
Mailing Address - Phone:617-520-4842
Mailing Address - Fax:
Practice Address - Street 1:45 SYCAMORE ST APT A
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02909-1933
Practice Address - Country:US
Practice Address - Phone:617-520-4842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program