Provider Demographics
NPI:1245439561
Name:DONALD V. FARGNOLI, M.D., INC.
Entity type:Organization
Organization Name:DONALD V. FARGNOLI, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:FARGNOLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-353-2525
Mailing Address - Street 1:1358 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02911-3304
Mailing Address - Country:US
Mailing Address - Phone:401-353-2525
Mailing Address - Fax:401-353-6792
Practice Address - Street 1:1358 SMITH ST
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02911-3304
Practice Address - Country:US
Practice Address - Phone:401-353-2525
Practice Address - Fax:401-353-6792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI5736207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI000762OtherHMO BLUE CHIP NEW ENGLAND
RI2879OtherNEIGHBORHOOD HEALTH PLAN
RI9000077Medicaid
RI0279OtherNEIGHBORHOOD HEALTH PLAN
RI000762OtherBLUE CHIP
RI0000000077OtherBLUE SHIELD OF RHODE ISLA
RI000762OtherBLUE CHIP FOR MEDICARE OP
RI180002352OtherRAILROAD MEDICARE
RI728575OtherTUFTS HEALTH PLAN
RI0800081OtherUNITED HEALTHCARE (INDIVI
RI000762OtherBLUE CHIP FOR MEDICARE
RI189000077OtherMEDICARE OF RHODE ISLAND
RI000762OtherBLUE CHIP FOR RITECARE
RI180002352OtherRAILROAD MEDICARE
RI189000077OtherMEDICARE OF RHODE ISLAND
RI728575OtherTUFTS HEALTH PLAN