Healthcare Provider Details

I. General information

NPI: 1609838697
Provider Name (Legal Business Name): GUY LANCELLOTTI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 02/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 CENTERVILLE RD SUITE 2
WARWICK RI
02886-4394
US

IV. Provider business mailing address

227 CENTERVILLE RD SUITE 2
WARWICK RI
02886-4394
US

V. Phone/Fax

Practice location:
  • Phone: 401-737-4828
  • Fax: 401-732-8484
Mailing address:
  • Phone: 401-737-4828
  • Fax: 401-732-8484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number6080
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number6080
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: