Healthcare Provider Details

I. General information

NPI: 1871691204
Provider Name (Legal Business Name): WEST BAY ORTHOPAEDICS AND NEUROSURGERY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 CENTERVILLE RD
WARWICK RI
02886-4336
US

IV. Provider business mailing address

120 CENTERVILLE RD
WARWICK RI
02886-4336
US

V. Phone/Fax

Practice location:
  • Phone: 401-738-3730
  • Fax: 401-738-3777
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: VAUGHN G GOODING
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 401-738-3730