Provider Demographics
NPI:1326149170
Name:METACOM MEDICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:METACOM MEDICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:AMALFITANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-245-1500
Mailing Address - Street 1:639 METACOM AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:RI
Mailing Address - Zip Code:02885
Mailing Address - Country:US
Mailing Address - Phone:401-245-1500
Mailing Address - Fax:401-247-2618
Practice Address - Street 1:639 METACOM AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:RI
Practice Address - Zip Code:02885
Practice Address - Country:US
Practice Address - Phone:401-245-1500
Practice Address - Fax:401-247-2618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9002628Medicaid
RI204049OtherBLUE CHIP GROUP NUMBER
RI9002628Medicaid
RI119002628Medicare PIN