Provider Demographics
NPI:1831857531
Name:SPALLINO, ANTHONY JOSEPH (PA-C)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JOSEPH
Last Name:SPALLINO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:593 EDDY STREET
Mailing Address - Street 2:APC 6
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903
Mailing Address - Country:US
Mailing Address - Phone:401-606-5891
Mailing Address - Fax:401-606-4692
Practice Address - Street 1:593 EDDY STREET
Practice Address - Street 2:APC 6
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903
Practice Address - Country:US
Practice Address - Phone:401-606-5891
Practice Address - Fax:401-606-4692
Is Sole Proprietor?:No
Enumeration Date:2021-11-30
Last Update Date:2023-09-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
RIPA01434363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant