Provider Demographics
NPI:1922030303
Name:MARCACCIO, PAUL THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:THOMAS
Last Name:MARCACCIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:639 METACOM AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:RI
Mailing Address - Zip Code:02885-2348
Mailing Address - Country:US
Mailing Address - Phone:401-245-1500
Mailing Address - Fax:401-247-2618
Practice Address - Street 1:639 METACOM AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:RI
Practice Address - Zip Code:02885-2348
Practice Address - Country:US
Practice Address - Phone:401-245-1500
Practice Address - Fax:401-247-2618
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD07879207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7003986Medicaid
RI7003986Medicaid
RI007004451Medicare PIN