Healthcare Provider Details

I. General information

NPI: 1518907302
Provider Name (Legal Business Name): SPECTRUM FAMILY HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 NEWPORT AVE
PAWTUCKET RI
02861-3624
US

IV. Provider business mailing address

10 ORMS ST SUITE 110
PROVIDENCE RI
02904-2228
US

V. Phone/Fax

Practice location:
  • Phone: 401-475-4588
  • Fax: 401-475-4589
Mailing address:
  • Phone: 401-453-0666
  • Fax: 401-453-9619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MANOJ K GARG
Title or Position: PRESIDENT
Credential: MD
Phone: 401-475-4588