MEDICARE: DANIEL R GACCIONE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	MD07085	RI
2	207X00000X	Orthopaedic Surgery Physician	034988	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	010007085RI02	OTHER	RI	ANTHEM BC/BS
2	0901058	OTHER		UNITED HEALTH
3	22654-7	OTHER	RI	BCBS
4	2V1386	OTHER		HEALTHNET
5	010034988CT02	OTHER	CT	ANTHEM BC/BS

General Provider Information

NPI Number	:	1538168117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL R GACCIONE MD

Provider Business Mailing Address
First Line	:	101 AIRPORT RD.
Second Line	:
City	:	WESTERLY
State	:	RI
Zip	:	02891
Country	:	US
Telephone Number	:	401-596-0259
Fax Number	:	401-348-5934

Provider Business Practice Location Address
First Line	:	101 AIRPORT RD
Second Line	:
City	:	WESTERLY
State	:	RI
Zip	:	02891
Country	:	US
Telephone Number	:	401-596-0259
Fax Number	:	401-348-5934

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	09/12/2013

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