Provider Demographics
NPI:1063562486
Name:PALUMBO, WILLIAM ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ANTHONY
Last Name:PALUMBO
Suffix:
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 1:1637 MINERAL SPRING AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:N PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-4042
Mailing Address - Country:US
Mailing Address - Phone:401-353-5224
Mailing Address - Fax:
Practice Address - Street 1:1637 MINERAL SPRING AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:N PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-4042
Practice Address - Country:US
Practice Address - Phone:401-353-0330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI7181207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI007056510OtherMEDICARE ID-TYPE UNSPECIFIED
RI7004455Medicaid
RI1104801349OtherBUTLER HOSPITAL NPI
RI202145OtherBLUE CHIP
RI20333-3OtherBLUE CROSS
1093831646OtherBUTLER HOSPITAL PROFESSIONAL BILLING OFFICE NPI
RI7181OtherMEDICAL LICENCE
RI7181OtherMEDICAL LICENCE
RI7004455Medicaid
RI20333-3OtherBLUE CROSS