Provider Demographics
NPI:1669647012
Name:RICHARD P. SAN ANTONIO M.D. FACC INC.
Entity Type:Organization
Organization Name:RICHARD P. SAN ANTONIO M.D. FACC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:SAN ANTONIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-738-2601
Mailing Address - Street 1:215 TOLL GATE RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4458
Mailing Address - Country:US
Mailing Address - Phone:401-738-2601
Mailing Address - Fax:401-738-2660
Practice Address - Street 1:215 TOLL GATE RD
Practice Address - Street 2:SUITE 305
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4458
Practice Address - Country:US
Practice Address - Phone:401-738-2601
Practice Address - Fax:401-738-2660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P12043590OtherMULTIPLAN
0005592221OtherAETNA
AA39929OtherHARVARD/PILGRIM
RI9000485Medicaid
RI000485OtherBLUECROSS
006410OtherTUFTS
RI2500217OtherUNITED HEALTH
006410OtherTUFTS
C90013Medicare UPIN
RI709006123Medicare PIN