Provider Demographics
NPI:1508924580
Name:FARGNOLI, DONALD VINCENT (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:VINCENT
Last Name:FARGNOLI
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 1:1358 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02911-3304
Mailing Address - Country:US
Mailing Address - Phone:401-353-2525
Mailing Address - Fax:401-353-6792
Practice Address - Street 1:1358 SMITH ST
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02911-3304
Practice Address - Country:US
Practice Address - Phone:401-353-2525
Practice Address - Fax:401-353-6792
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI5736207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9000077Medicaid
RIC89740Medicare UPIN