Provider Demographics
NPI:1396806352
Name:PALATUCCI, MICHAEL M (PAC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:M
Last Name:PALATUCCI
Suffix:
Gender:M
Credentials:PAC
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 215
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-4055
Mailing Address - Country:US
Mailing Address - Phone:401-353-7330
Mailing Address - Fax:401-354-4760
Practice Address - Street 1:1637 MINERAL SPRING AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-4055
Practice Address - Country:US
Practice Address - Phone:401-353-7330
Practice Address - Fax:401-354-4760
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00260207RG0300X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI238474OtherBCBS
RI9023720Medicaid
RI408945OtherBLUE CHIP
RI408945OtherBLUE CHIP
RI9023720Medicaid