Provider Demographics
NPI:1902886757
Name:NORTH PROVIDENCE PRIMARY CARE ASSOC INC
Entity Type:Organization
Organization Name:NORTH PROVIDENCE PRIMARY CARE ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:G
Authorized Official - Last Name:FARINA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:401-351-1900
Mailing Address - Street 1:1830 MINERAL SPRING AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-3864
Mailing Address - Country:US
Mailing Address - Phone:401-351-1900
Mailing Address - Fax:401-270-3080
Practice Address - Street 1:1830 MINERAL SPRING AVE
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-3864
Practice Address - Country:US
Practice Address - Phone:401-351-1900
Practice Address - Fax:401-270-3080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI 8466207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0406635OtherUNITED
RI232780OtherBC BS
RI232780OtherBC BS
RI0406635OtherUNITED
F96933Medicare UPIN