Provider Demographics
NPI:1568439560
Name:MIGNONE, ROBERT J (MD, FAPA)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:MIGNONE
Suffix:
Gender:M
Credentials:MD, FAPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 MAIN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:TIVERTON
Mailing Address - State:RI
Mailing Address - Zip Code:02878-4625
Mailing Address - Country:US
Mailing Address - Phone:401-816-5672
Mailing Address - Fax:401-816-5692
Practice Address - Street 1:1804 MAIN RD
Practice Address - Street 2:SUITE B
Practice Address - City:TIVERTON
Practice Address - State:RI
Practice Address - Zip Code:02878-4625
Practice Address - Country:US
Practice Address - Phone:401-816-5672
Practice Address - Fax:401-816-5692
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD118092084P0800X
MA321462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA002350504Medicare PIN
RI0023504Medicare PIN