Provider Demographics
NPI:1962492264
Name:FIORENTINO, JAMES (PA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:FIORENTINO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 PLEASANT ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721-3005
Mailing Address - Country:US
Mailing Address - Phone:508-678-2503
Mailing Address - Fax:508-646-7641
Practice Address - Street 1:289 PLEASANT ST
Practice Address - Street 2:SUITE 202
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-3005
Practice Address - Country:US
Practice Address - Phone:508-678-2503
Practice Address - Fax:508-646-7641
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA494363AS0400X
MARN154375163W00000X
RIPA00055363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S26487Medicare UPIN
AP0272Medicare PIN