Healthcare Provider Details

I. General information

NPI: 1720180367
Provider Name (Legal Business Name): MARY LOUISE GIOVETTI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2006
Last Update Date: 09/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 BRIDGE WAY
PASCOAG RI
02859-3131
US

IV. Provider business mailing address

36 THE BRIDGEWAY NORTHWEST HEALTH CENTER
PASCOAG RI
02859
US

V. Phone/Fax

Practice location:
  • Phone: 401-568-7661
  • Fax: 401-568-7949
Mailing address:
  • Phone: 401-568-7661
  • Fax: 401-568-7949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberRI7491
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: