Healthcare Provider Details

I. General information

NPI: 1740422401
Provider Name (Legal Business Name): ALEXIS C. GIMOVSKY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2009
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 PLAIN ST FL 6
PROVIDENCE RI
02903-4829
US

IV. Provider business mailing address

101 PLAIN ST FL 6
PROVIDENCE RI
02903-4829
US

V. Phone/Fax

Practice location:
  • Phone: 401-274-1122
  • Fax: 401-453-7622
Mailing address:
  • Phone: 401-274-1122
  • Fax: 401-453-7622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberMD16937
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD16937
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number278058
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberMD043953B
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: