Provider Demographics
NPI:1396794996
Name:RALPH A DIGIACOMO MD PC
Entity type:Organization
Organization Name:RALPH A DIGIACOMO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:DIGIACOMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-738-1576
Mailing Address - Street 1:215 TOLL GATE ROAD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886
Mailing Address - Country:US
Mailing Address - Phone:401-738-1576
Mailing Address - Fax:401-732-8846
Practice Address - Street 1:215 TOLL GATE ROAD
Practice Address - Street 2:SUITE 303
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886
Practice Address - Country:US
Practice Address - Phone:401-738-1576
Practice Address - Fax:401-732-8846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI6546207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0004943Medicaid
RI0004943Medicaid