Provider Demographics
NPI:1679640767
Name:FARINA, ANTHONY G JR (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:G
Last Name:FARINA
Suffix:JR
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 1:1830 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI8466207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI007010478Medicare ID - Type Unspecified
F96933Medicare UPIN