Healthcare Provider Details

I. General information

NPI: 1427787324
Provider Name (Legal Business Name): VICTORIA ROSE GAO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 MAUDE ST
PROVIDENCE RI
02908-4325
US

IV. Provider business mailing address

7 SHERATON DR
BRISTOL RI
02809-2829
US

V. Phone/Fax

Practice location:
  • Phone: 732-451-4318
  • Fax:
Mailing address:
  • Phone: 401-441-2070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: