Healthcare Provider Details

I. General information

NPI: 1538168117
Provider Name (Legal Business Name): DANIEL R GACCIONE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 09/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 AIRPORT RD
WESTERLY RI
02891
US

IV. Provider business mailing address

101 AIRPORT RD.
WESTERLY RI
02891
US

V. Phone/Fax

Practice location:
  • Phone: 401-596-0259
  • Fax: 401-348-5934
Mailing address:
  • Phone: 401-596-0259
  • Fax: 401-348-5934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD07085
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number034988
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: