Provider Demographics
NPI:1356344089
Name:DECESARIS, VINCENT A (MD)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:A
Last Name:DECESARIS
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 1:125 METRO CENTER BLVD STE 2000
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1785
Mailing Address - Country:US
Mailing Address - Phone:401-432-2500
Mailing Address - Fax:401-453-8220
Practice Address - Street 1:125 METRO CENTER BLVD STE 2000
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1785
Practice Address - Country:US
Practice Address - Phone:401-432-2500
Practice Address - Fax:401-453-8220
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA807772085R0202X
RIMD044102085U0001X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT034414OtherCT LICENSE
MA80777OtherMA LICENSE
RIMD04410OtherRI LICENSE
RI7000162Medicaid
ME014362OtherME LICENSE
NH9565OtherNH LICENSE
MA3123898Medicaid
MADE-A40377Medicare ID - Type UnspecifiedMASSACHUSETTS MEDICARE
ME014362OtherME LICENSE
MA3123898Medicaid
D87169Medicare UPIN