Healthcare Provider Details

I. General information

NPI: 1609133008
Provider Name (Legal Business Name): KAREN L MCGOLDRICK, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2012
Last Update Date: 04/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 PLAIN ST 101A
PROVIDENCE RI
02905-3240
US

IV. Provider business mailing address

235 PLAIN ST 101A
PROVIDENCE RI
02905-3240
US

V. Phone/Fax

Practice location:
  • Phone: 401-751-5111
  • Fax: 401-751-2646
Mailing address:
  • Phone: 401-751-5111
  • Fax: 401-751-2646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name: KAREN L MCGOLDRICK
Title or Position: OWNER
Credential: MD
Phone: 401-751-5111