Provider Demographics
NPI:1780623470
Name:COLAGIOVANNI, STEVEN MARC (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:MARC
Last Name:COLAGIOVANNI
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 1:1524 ATWOOD AVE
Mailing Address - Street 2:SUITE 322
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-3228
Mailing Address - Country:US
Mailing Address - Phone:401-331-7400
Mailing Address - Fax:401-331-7410
Practice Address - Street 1:1524 ATWOOD AVE
Practice Address - Street 2:SUITE 322
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-3228
Practice Address - Country:US
Practice Address - Phone:401-331-7400
Practice Address - Fax:401-331-7410
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD08650174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RISC08504Medicaid
RIF86224Medicare UPIN