Healthcare Provider Details

I. General information

NPI: 1780782706
Provider Name (Legal Business Name): GASTROENTEROLOGY SPECIALISTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 WELLS ST SUITE 103
WESTERLY RI
02891-2927
US

IV. Provider business mailing address

45 WELLS ST SUITE 103
WESTERLY RI
02891-2927
US

V. Phone/Fax

Practice location:
  • Phone: 401-596-6330
  • Fax: 401-348-0420
Mailing address:
  • Phone: 401-596-6330
  • Fax: 401-348-0420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEBORAH GERVASINI
Title or Position: OFFICE MANAGER
Credential:
Phone: 401-596-6330