Healthcare Provider Details

I. General information

NPI: 1831026053
Provider Name (Legal Business Name): JOSHUA FREEMAN GERRY PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1287 N MAIN ST
PROVIDENCE RI
02904-1856
US

IV. Provider business mailing address

1287 N MAIN ST
PROVIDENCE RI
02904-1856
US

V. Phone/Fax

Practice location:
  • Phone: 401-272-2724
  • Fax: 401-272-2784
Mailing address:
  • Phone: 401-272-2724
  • Fax: 401-272-2784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA102802
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA01925
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: