Provider Demographics
NPI:1710154364
Name:DIGIACOMO, RALPH AMEDEO (MD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:AMEDEO
Last Name:DIGIACOMO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:215 TOLL GATE RD
Mailing Address - Street 2:STE 303
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4462
Mailing Address - Country:US
Mailing Address - Phone:401-738-1576
Mailing Address - Fax:401-732-8846
Practice Address - Street 1:215 TOLL GATE RD
Practice Address - Street 2:STE 303
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4458
Practice Address - Country:US
Practice Address - Phone:401-738-1576
Practice Address - Fax:401-732-8846
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RI06546207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0004943RIMedicaid
RI669020137RIMedicare PIN
RI0004943RIMedicaid