Healthcare Provider Details

I. General information

NPI: 1669745147
Provider Name (Legal Business Name): CHRISTOPHER GELINAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2012
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 EDDIE DOWLING HWY UNIT LLA
NORTH SMITHFIELD RI
02896-7337
US

IV. Provider business mailing address

117 EDDIE DOWLING HWY UNIT LLA
NORTH SMITHFIELD RI
02896-7337
US

V. Phone/Fax

Practice location:
  • Phone: 401-636-4870
  • Fax:
Mailing address:
  • Phone: 401-636-4870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC529
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: