Provider Demographics
NPI:1124080254
Name:ROLAND, FREDY P (MD)
Entity type:Individual
Prefix:DR
First Name:FREDY
Middle Name:P
Last Name:ROLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:333 SCHOOL ST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-5334
Mailing Address - Country:US
Mailing Address - Phone:401-722-1880
Mailing Address - Fax:401-726-0920
Practice Address - Street 1:333 SCHOOL ST
Practice Address - Street 2:SUITE 215
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-5334
Practice Address - Country:US
Practice Address - Phone:401-722-1880
Practice Address - Fax:401-726-0920
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RI06717207R00000X
RIMD06717207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9000070Medicaid
RI119000070Medicare UPIN
RIC90494Medicare UPIN