Provider Demographics
NPI:1205942646
Name:FORTUNATO, DAVID J (MD)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:J
Last Name:FORTUNATO
Suffix:
Gender:
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:PO BOX 8879
Mailing Address - Street 2:UNIT 406
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-0879
Mailing Address - Country:US
Mailing Address - Phone:401-572-3120
Mailing Address - Fax:401-572-3351
Practice Address - Street 1:75 S UNION ST
Practice Address - Street 2:UNIT 406
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-3978
Practice Address - Country:US
Practice Address - Phone:401-741-3154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2025-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI5244207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI900525Medicaid
5256OtherBCBS RI
RIDF09421Medicaid
000812OtherBLUE CHIP
5256OtherBCBS RI
000812OtherBLUE CHIP