Healthcare Provider Details

I. General information

NPI: 1801982491
Provider Name (Legal Business Name): ALTAF AHMED GIRACH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2138 MENDON RD SUITE 101A
CUMBERLAND RI
02864
US

IV. Provider business mailing address

2138 MENDON RD SUITE 101A
CUMBERLAND RI
02864-3834
US

V. Phone/Fax

Practice location:
  • Phone: 401-333-8500
  • Fax: 401-333-2191
Mailing address:
  • Phone: 401-333-8500
  • Fax: 401-333-2191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD10508
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberMD10508
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: