Provider Demographics
NPI:1861694069
Name:ROBERT H. JANIGIAN JR. MD LLC
Entity type:Organization
Organization Name:ROBERT H. JANIGIAN JR. MD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:JANIGIAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:401-369-7773
Mailing Address - Street 1:P. O. BOX 848817
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-8817
Mailing Address - Country:US
Mailing Address - Phone:401-369-7773
Mailing Address - Fax:401-369-7336
Practice Address - Street 1:120 DUDLEY ST
Practice Address - Street 2:SUITE 303
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-2436
Practice Address - Country:US
Practice Address - Phone:401-369-7773
Practice Address - Fax:401-369-7336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI8336207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7003304Medicaid
MA3109356Medicaid
RI0011008Medicare PIN
RI7003304Medicaid