Provider Demographics
NPI:1356323067
Name:ZINGALE, PHILIP W (PA-C)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:W
Last Name:ZINGALE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1539 ATWOOD AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-3262
Mailing Address - Country:US
Mailing Address - Phone:401-521-6080
Mailing Address - Fax:401-521-6092
Practice Address - Street 1:1524 ATWOOD AVE
Practice Address - Street 2:SUITE 245
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-3228
Practice Address - Country:US
Practice Address - Phone:401-521-6080
Practice Address - Fax:401-521-6092
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICPA00014363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI407350OtherBLUE CHIP
RI2156-4OtherBLUE CROSS
41D0695381OtherCLIA
RI407350OtherBLUE CHIP
41D0695381OtherCLIA