Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 8086 | RI |
NPI | 1003940156 |
---|---|
Provider Name | Dr. Anthony Joseph De Luca |
First Address | Bristol, RI 02809-1593 |
Second Address | Barrington, RI 02806-3430 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AD 00178 | (05) | RI |
G-17787 | (02) | RI |