Provider Demographics
NPI:1992766679
Name:SADANIANTZ, ARA (MD)
Entity type:Individual
Prefix:
First Name:ARA
Middle Name:
Last Name:SADANIANTZ
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 1:333 SCHOOL STREET
Mailing Address - Street 2:SUITE 112
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-5335
Mailing Address - Country:US
Mailing Address - Phone:401-723-1210
Mailing Address - Fax:401-312-2099
Practice Address - Street 1:ONE RANDALL SQUARE
Practice Address - Street 2:SUITE 305
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02940-7405
Practice Address - Country:US
Practice Address - Phone:401-223-0223
Practice Address - Fax:401-312-2099
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD06890207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9006307Medicaid
007050502Medicare ID - Type Unspecified
007060914Medicare PIN
C90112Medicare UPIN
RI069006280Medicare PIN