| Fairlawn Primary Care, Inc | |
|
886 Mineral Spring Ave Pawtucket RI 02860-3322 | |
| (401) 475-3063 | |
| Not Available |
| Full Name | Fairlawn Primary Care, Inc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 886 Mineral Spring Ave, Pawtucket, Rhode Island |
| Authorized Official Name and Position | Holly Fernandes (PRESIDENT) |
| Authorized Official Contact | 4014753063 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fairlawn Primary Care, Inc 886 Mineral Spring Ave Pawtucket RI 02860-3322 Ph: () - | Fairlawn Primary Care, Inc 886 Mineral Spring Ave Pawtucket RI 02860-3322 Ph: (401) 475-3063 |
| NPI Number | 1508898909 |
|---|---|
| Provider Enumeration Date | 07/07/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 0941289375 |
|---|---|
| Medicare Enrollment ID | O20040719000427 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508898909 | NPI | - | NPPES |
| 9003461 | Medicaid | RI | |
| 7006714 | Medicaid | RI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 09843 (Rhode Island) | Primary |
| 363LF0000X | Nurse Practitioner - Family | NPP37132 (Rhode Island) | Primary |
| Provider Name | Fadi Mansourati |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548245962 PECOS PAC ID: 4082623640 Enrollment ID: I20060411000284 |
| Provider Name | Constance Ducharme |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114558244 PECOS PAC ID: 6901235530 Enrollment ID: I20200402003429 |
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