Healthcare Provider Details

I. General information

NPI: 1629076351
Provider Name (Legal Business Name): GISELE SALIBA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 ATWOOD AVE
PROVIDENCE RI
02919-3228
US

IV. Provider business mailing address

1524 ATWOOD AVE
PROVIDENCE RI
02919-3228
US

V. Phone/Fax

Practice location:
  • Phone: 401-272-1900
  • Fax: 401-453-3049
Mailing address:
  • Phone: 401-272-1900
  • Fax: 401-453-3049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD09480
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: