Provider Demographics
NPI:1346228988
Name:SAN ANTONIO, RICHARD P (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:P
Last Name:SAN ANTONIO
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 1:215 TOLL GATE RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4458
Mailing Address - Country:US
Mailing Address - Phone:401-738-2601
Mailing Address - Fax:401-738-2660
Practice Address - Street 1:215 TOLL GATE RD
Practice Address - Street 2:SUITE 305
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4458
Practice Address - Country:US
Practice Address - Phone:401-738-2601
Practice Address - Fax:401-738-2660
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI6410207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
006410OtherTUFTS
RI9000485Medicaid
AA39929OtherHARVARD PILGRIM
050415620OtherCIGNA
RI2500217OtherUNITED HEALTH
0005592221OtherAETNA
RI000485OtherBLUE CROSS
P12043590OtherMULTI PLAN
AA39929OtherHARVARD PILGRIM
RI9000485Medicaid