Healthcare Provider Details

I. General information

NPI: 1831173301
Provider Name (Legal Business Name): MEDICAL & RENAL ASSO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 CENTERVILLE RD WARWICK EXECUTIVE PARK
WARWICK RI
02886-4382
US

IV. Provider business mailing address

250 CENTERVILLE RD WARWICK EXECUTIVE PARK
WARWICK RI
02886-4382
US

V. Phone/Fax

Practice location:
  • Phone: 401-739-7380
  • Fax: 401-737-7558
Mailing address:
  • Phone: 401-739-7380
  • Fax: 401-737-7558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. OWEN BERNARD GILMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 401-739-7380