Active NPI
Agape Dermatology of Johnston LLC
- Dermatology Physician
- Johnston, RI
National Provider Identifier
1871304337
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- Legal business name
- AGAPE DERMATOLOGY OF JOHNSTON LLC
- Practice address
- 1526 Atwood Ave Ste 220
Johnston, RI 02919-3289 - Phone
- (401) 396-2227
- Fax
- (401) 421-1120
- NPI assigned
- Jan 15, 2025
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Paul Mallari
- Title
- Ceo
- Phone
- (508) 674-4000
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | Primary |
Addresses
Primary practice location
1526 Atwood Ave Ste 220
Johnston, RI 02919-3289
Mailing address
1526 Atwood Ave Ste 220
Johnston, RI 02919-3289
Phone (401) 737-7546
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in RI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250522001564 | RI | Part B Supplier - Clinic/Group Practice | 2860911856 |
Receives reassigned benefits from 4 practitioners Practice locations: Johnston, RI |
National Provider Directory
National Provider DirectoryLocations
1526 Atwood Ave
Ste 210
Johnston, RI 02919
Phone (401) 396-2227
Practitioners 4
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1736899200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1787184000000",
"number": "1871304337",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1526 ATWOOD AVE STE 220",
"city": "JOHNSTON",
"state": "RI",
"postal_code": "029193289",
"telephone_number": "401-737-7546",
"fax_number": "401-421-1120"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1526 ATWOOD AVE STE 220",
"city": "JOHNSTON",
"state": "RI",
"postal_code": "029193289",
"telephone_number": "401-396-2227",
"fax_number": "401-421-1120"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AGAPE DERMATOLOGY OF JOHNSTON LLC",
"organizational_subpart": "NO",
"enumeration_date": "2025-01-15",
"last_updated": "2026-08-20",
"certification_date": "2026-08-20",
"status": "A",
"authorized_official_last_name": "MALLARI",
"authorized_official_first_name": "PAUL",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "508-674-4000"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dermatology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Johnston, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.