Provider Demographics
NPI:1760568216
Name:ANGELA FISHMAN, D.O., INC.
Entity Type:Organization
Organization Name:ANGELA FISHMAN, D.O., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:401-421-8800
Mailing Address - Street 1:33 STANIFORD ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-3105
Mailing Address - Country:US
Mailing Address - Phone:401-421-8800
Mailing Address - Fax:401-273-6510
Practice Address - Street 1:1407 SOUTH COUNTY TRAIL
Practice Address - Street 2:BUILDING 4 SUITE 410
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-5079
Practice Address - Country:US
Practice Address - Phone:401-886-4040
Practice Address - Fax:401-886-4010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI547207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty