Provider Demographics
NPI:1770280679
Name:DISEGNA, PAUL AUGUST
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:AUGUST
Last Name:DISEGNA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ENERGY-
Other - Middle Name:N-
Other - Last Name:ELEMENTS, LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5 IVES BLUFF CT
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-4634
Mailing Address - Country:US
Mailing Address - Phone:401-736-6500
Mailing Address - Fax:
Practice Address - Street 1:5 IVES BLUFF CT
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-4634
Practice Address - Country:US
Practice Address - Phone:401-736-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-10
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175L00000X
RI813920175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175L00000XOther Service ProvidersHomeopathGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI45-3147397OtherSELF
RI45-3147397OtherHOLISTIC
RI45-3147397OtherN/A