Healthcare Provider Details

I. General information

NPI: 1922627710
Provider Name (Legal Business Name): TYLER P MCGEE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2020
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 METRO CENTER BLVD STE 2000
WARWICK RI
02886-1785
US

IV. Provider business mailing address

1588 MAIN ST
WEST BARNSTABLE MA
02668-1139
US

V. Phone/Fax

Practice location:
  • Phone: 401-921-9202
  • Fax: 401-921-9212
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA7994
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA01303
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: