Healthcare Provider Details

I. General information

NPI: 1023006988
Provider Name (Legal Business Name): GREGORY IAFRATE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 09/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 CATAMORE BLVD
EAST PROVIDENCE RI
02914-1204
US

IV. Provider business mailing address

20 CATAMORE BLVD
EAST PROVIDENCE RI
02914-1204
US

V. Phone/Fax

Practice location:
  • Phone: 401-432-2520
  • Fax: 401-432-2457
Mailing address:
  • Phone: 401-432-2520
  • Fax: 401-432-2457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number11744
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: