Provider Demographics
NPI:1164412227
Name:VERGNANI, ROBERT J (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:VERGNANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1565 N MAIN ST
Mailing Address - Street 2:STE 406
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-2972
Mailing Address - Country:US
Mailing Address - Phone:508-677-0041
Mailing Address - Fax:508-677-0975
Practice Address - Street 1:1565 N MAIN ST
Practice Address - Street 2:STE 406
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-2972
Practice Address - Country:US
Practice Address - Phone:508-677-0041
Practice Address - Fax:508-677-0975
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA37907207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2033933Medicaid
MA2033933Medicaid
MAK08304Medicare ID - Type Unspecified