Healthcare Provider Details

I. General information

NPI: 1386952612
Provider Name (Legal Business Name): UNIVERSITY GASTROENTEROLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2010
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 STANIFORD ST
PROVIDENCE RI
02905
US

IV. Provider business mailing address

33 STANIFORD ST
PROVIDENCE RI
02905-3105
US

V. Phone/Fax

Practice location:
  • Phone: 401-421-8800
  • Fax: 401-273-6510
Mailing address:
  • Phone: 401-421-8800
  • Fax: 401-273-6510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM T. CHEN
Title or Position: PROIVDER
Credential:
Phone: 401-421-8800