Healthcare Provider Details

I. General information

NPI: 1497275465
Provider Name (Legal Business Name): CAITLIN ANN GILLOOLY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 PROVIDENCE ST
WEST WARWICK RI
02893-2508
US

IV. Provider business mailing address

186 PROVIDENCE ST
WEST WARWICK RI
02893-2508
US

V. Phone/Fax

Practice location:
  • Phone: 401-615-2800
  • Fax: 401-152-8056
Mailing address:
  • Phone: 401-615-2800
  • Fax: 401-615-2805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD17060
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: