Provider Demographics
NPI:1205286143
Name:PALOMBO, ANGELINA (MD)
Entity type:Individual
Prefix:
First Name:ANGELINA
Middle Name:
Last Name:PALOMBO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1126 HARTFORD AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-7109
Mailing Address - Country:US
Mailing Address - Phone:401-519-1940
Mailing Address - Fax:401-273-2919
Practice Address - Street 1:111 BREWSTER ST
Practice Address - Street 2:FCC TEAM A
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-4474
Practice Address - Country:US
Practice Address - Phone:401-729-2304
Practice Address - Fax:401-729-2541
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RILP03786207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIRES000Medicare UPIN