| Name: | Frank P. Maggiacomo, D.O., Inc./MOC |
| Jurisdiction: | Rhode Island |
| Entity type: | Professional Service Corporation |
| Status: | Activ |
| Date of Organization in Rhode Island: | 09 Jul 1991 (34 years ago) |
| Identification Number: | 000064937 |
| ZIP code: | 02920 |
| County: | Providence County |
| Principal Address: | 1681 CRANSTON STREET, CRANSTON, RI, 02920, USA |
| Purpose: | PRACTICE OF MEDICINE |
| NAICS: | 621111 - Offices of Physicians (except Mental Health Specialists) |
| Historical names: |
Frank P. Maggiacomo, D.O., Inc. |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1124217674 | 2007-10-22 | 2007-10-22 | 1681 CRANSTON ST, SUITE D, CRANSTON, RI, 029205000, US | 1681 CRANSTON ST, SUITE D, CRANSTON, RI, 029205000, US | |||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||
| Phone | +1 401-946-8446 |
| Fax | 4019468340 |
Authorized person
| Name | DR. FRANK P MAGGIACOMO |
| Role | PRESIDENT |
| Phone | 4019468446 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | DO 00383 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PTAN |
| Number | 119003084 |
| State | RI |
| Issuer | MEDICAID |
| Number | FM27448 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| ROBERT RASTELLI | Agent | 1681 CRANSTON STREET SUITE D, CRANSTON, RI, 02920, USA |
| Name | Role | Address |
|---|---|---|
| FRANK P MAGGIACOMO DO | PRESIDENT | 1681 CRANSTON STREET CRANSTON, RI 02920 USA |
| Type | Date | Old Value | New Value |
|---|---|---|---|
| Name Change | 2018-07-10 | Frank P. Maggiacomo, D.O., Inc. | Frank P. Maggiacomo, D.O., Inc./MOC |
| Number | Name | File Date |
|---|---|---|
| 202458596450 | Annual Report | 2024-08-06 |
| 202457124500 | Revocation Notice For Failure to File An Annual Report | 2024-06-25 |
| 202339754900 | Annual Report | 2023-07-25 |
| 202338011400 | Revocation Notice For Failure to File An Annual Report | 2023-06-19 |
| 202218676200 | Annual Report | 2022-06-21 |
| 202198512460 | Annual Report | 2021-06-22 |
| 202196756000 | Revocation Notice For Failure to File An Annual Report | 2021-05-19 |
| 202046507040 | Annual Report | 2020-07-27 |
| 201927612860 | Annual Report | 2019-11-18 |
| 201927612950 | Statement of Change of Registered/Resident Agent | 2019-11-18 |
Date of last update: 07 Oct 2024
Sources: Rhode Island Department of State
