Provider Demographics
NPI:1841588365
Name:R J MIGNONE MD AND ASSOCIATES PC
Entity Type:Organization
Organization Name:R J MIGNONE MD AND ASSOCIATES PC
Other - Org Name:STONE BRIDGE PSYCHIATRIC ASSOCIATES PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:MIGNONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-816-5672
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-18
Last Update Date:2014-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD118092084P0800X
MA321462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA002350504Medicare PIN
RI0023504Medicare PIN
RIA35088Medicare UPIN