Healthcare Provider Details

I. General information

NPI: 1922042514
Provider Name (Legal Business Name): JONATHAN A GASTEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 TOLL GATE RD
WARWICK RI
02886-2759
US

IV. Provider business mailing address

455 TOLL GATE RD
WARWICK RI
02886-2759
US

V. Phone/Fax

Practice location:
  • Phone: 401-729-2800
  • Fax: 401-729-2877
Mailing address:
  • Phone: 401-729-2800
  • Fax: 401-729-2877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD09469
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: