Healthcare Provider Details

I. General information

NPI: 1609186337
Provider Name (Legal Business Name): MANOJ GURUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2010
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 TOLL GATE RD KENT HOSPITAL
WARWICK RI
02886-2759
US

IV. Provider business mailing address

27 CEDAR POND DR APT-7
WARWICK RI
02886-6638
US

V. Phone/Fax

Practice location:
  • Phone: 401-737-7000
  • Fax:
Mailing address:
  • Phone: 585-755-1241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD14351
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD14351
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: