Individual
MS. LAURA FAVICCHIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
125 METRO CENTER BLVD STE 2000, WARWICK, RI 02886-1785
(401) 432-2500
(401) 453-8220
Mailing address
125 METRO CENTER BLVD STE 2000, WARWICK, RI 02886-1785
(401) 432-2500
(401) 453-8220
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00737
RI
363A00000X
Physician Assistant
PA3844
MA
363AS0400X
Surgical Physician Assistant
PA00737
RI
363AS0400X
Surgical Physician Assistant
PA3844
MA
Other
Enumeration date
10/15/2009
Last updated
09/30/2020
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