Healthcare Provider Details

I. General information

NPI: 1871236992
Provider Name (Legal Business Name): TIMOTHY RICHARD GRAZIANO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2022
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 TOLL GATE RD
WARWICK RI
02886-2759
US

IV. Provider business mailing address

110 SAW MILL DR APT 310
NORTH KINGSTOWN RI
02852-2536
US

V. Phone/Fax

Practice location:
  • Phone: 401-737-7010
  • Fax:
Mailing address:
  • Phone: 716-908-1378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberLP06640
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: