Provider Demographics
NPI:1598943250
Name:SORIANO PISATURO, MARIA AILEEN A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA AILEEN
Middle Name:A
Last Name:SORIANO PISATURO
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 1:825 CHALKSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-4728
Mailing Address - Country:US
Mailing Address - Phone:401-456-6783
Mailing Address - Fax:
Practice Address - Street 1:215 TOLL GATE RD STE 104
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4463
Practice Address - Country:US
Practice Address - Phone:401-921-7290
Practice Address - Fax:401-921-6194
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA237882207RH0002X, 207R00000X
OH35091008207R00000X
OH91008207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM20518Medicare PIN