Provider Demographics
NPI:1235305871
Name:AGAPE PRIMARY CARE AND LASER CENTER LLC
Entity Type:Organization
Organization Name:AGAPE PRIMARY CARE AND LASER CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:D'ALESSANDRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-654-4433
Mailing Address - Street 1:1195 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-1824
Mailing Address - Country:US
Mailing Address - Phone:401-654-4433
Mailing Address - Fax:
Practice Address - Street 1:1195 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-1824
Practice Address - Country:US
Practice Address - Phone:401-654-4433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-04
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD10894207N00000X
RIMD08003207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty