Provider Demographics
NPI:1538189964
Name:NORTHERN RHODE ISLAND MEDICAL GROUP, PC
Entity type:Organization
Organization Name:NORTHERN RHODE ISLAND MEDICAL GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FATHALLA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MASHALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-490-2130
Mailing Address - Street 1:42 HEMINGWAY DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-2224
Mailing Address - Country:US
Mailing Address - Phone:401-490-2130
Mailing Address - Fax:
Practice Address - Street 1:25 JOHN A CUMMINGS WAY
Practice Address - Street 2:NORTHERN RHODE ISLAND MEDICAL GROUP, PC
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-3224
Practice Address - Country:US
Practice Address - Phone:401-766-6066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Not Answered207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Not Answered208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9003525Medicaid
MA9732730Medicaid
MA9732730Medicaid