Individual
ANDREW FODERARO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
593 EDDY ST, PROVIDENCE, RI 02903-4923
(401) 444-4742
(401) 444-4445
Mailing address
15 LA SALLE SQ, PROVIDENCE, RI 02903-1814
(401) 444-6779
(401) 444-6912
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
MD14723
RI
207RP1001X
Pulmonary Disease Physician
Primary
MD14723
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1700179942
—
RI
Enumeration date
05/20/2011
Last updated
03/05/2026
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