Basic Information
Provider Information
NPI: 1003293671
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VILLASANTE FRICKE
FirstName: ALEXANDRA
MiddleName: CRISTINA
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: VILLASANTE
OtherFirstName: ALEXANDRA
OtherMiddleName: CRISTINA
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 593 EDDY STREET
Address2:  
City: PROVIDENCE
State: RI
PostalCode: 02903
CountryCode: US
TelephoneNumber: 4014444741
FaxNumber: 4014444445
Practice Location
Address1: 593 EDDY ST
Address2:  
City: PROVIDENCE
State: RI
PostalCode: 029034923
CountryCode: US
TelephoneNumber: 4014444741
FaxNumber: 4014444445
Other Information
ProviderEnumerationDate: 05/02/2015
LastUpdateDate: 08/15/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XLP03808RIY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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