Healthcare Provider Details

I. General information

NPI: 1295662856
Provider Name (Legal Business Name): SAMUEL ALEXANDER GINGRAS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1150 DOUGLAS PIKE
SMITHFIELD RI
02917-1291
US

IV. Provider business mailing address

22 MASHPEE DR
NORTH ATTLEBORO MA
02760-4384
US

V. Phone/Fax

Practice location:
  • Phone: 401-232-6000
  • Fax:
Mailing address:
  • Phone: 508-212-2702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: