Provider Demographics
NPI:1407933419
Name:CIANCAGLINI, DOREEN M (MD)
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:M
Last Name:CIANCAGLINI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1169 MINERAL SPRING AVENUE
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-4102
Mailing Address - Country:US
Mailing Address - Phone:401-725-3888
Mailing Address - Fax:
Practice Address - Street 1:1169 MINERAL SPRING AVENUE
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-4102
Practice Address - Country:US
Practice Address - Phone:401-725-3888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI08931208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
008931OtherTUFTS MA
RI20614-7OtherBLUE CROSS
RI627126371Medicaid
RI20614-7OtherBLUE CROSS
RI379020614Medicare ID - Type Unspecified