Provider Demographics
NPI:1487651618
Name:MINIUTTI, JANE G (DO)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:G
Last Name:MINIUTTI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MILL RD
Mailing Address - Street 2:STE 180
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:1800 MAIN RD
Practice Address - Street 2:
Practice Address - City:TIVERTON
Practice Address - State:RI
Practice Address - Zip Code:02878-4625
Practice Address - Country:US
Practice Address - Phone:401-625-5552
Practice Address - Fax:401-625-5277
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIDO00436207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7003532Medicaid
RI7003532Medicaid
RI004737OtherRI BLUE CHIP
007003532Medicare ID - Type Unspecified
F39979Medicare UPIN