Healthcare Provider Details

I. General information

NPI: 1225065139
Provider Name (Legal Business Name): JENNIFER GASS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 DUDLEY ST
PROVIDENCE RI
02905-2401
US

IV. Provider business mailing address

101 DUDLEY ST
PROVIDENCE RI
02905-2401
US

V. Phone/Fax

Practice location:
  • Phone: 401-274-1100
  • Fax:
Mailing address:
  • Phone: 401-274-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD08540
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberMD08540
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD08540
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: