Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | MD16123 | RI |
NPI | 1386900165 |
---|---|
Provider Name | Jason Tartaglione |
First Address | Warwick, RI 02886-4336 |
Second Address | Warwick, RI 02886-4336 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2012 |
Last Update Date | 17/03/2018 |