Provider Demographics
NPI:1912098336
Name:FUENTES, MIGUEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:A
Last Name:FUENTES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:967 MINERAL SPRING AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-4934
Mailing Address - Country:US
Mailing Address - Phone:401-312-0444
Mailing Address - Fax:401-312-0446
Practice Address - Street 1:967 MINERAL SPRING AVE
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-4934
Practice Address - Country:US
Practice Address - Phone:401-312-0444
Practice Address - Fax:401-312-0446
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD 84992080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI406110OtherTUFTS
RIMS47209Medicaid
RI12-02799OtherUNITED HEALTH PLAN
RI004777OtherBLUE CHIP
RI1680OtherNEIGHBORHOOD HEALTH PLAN
RI22699-4OtherBLUE CROSS & BS
RIMS47209Medicaid