Healthcare Provider Details

I. General information

NPI: 1043150725
Provider Name (Legal Business Name): AMELIA HALES GAGLIUSO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 DUDLEY ST
PROVIDENCE RI
02905-2401
US

IV. Provider business mailing address

21 ELTON ST # 2
PROVIDENCE RI
02906-4105
US

V. Phone/Fax

Practice location:
  • Phone: 201-274-1100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number1043150725
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: