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General NPI Number Information
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NPI Number | 1083425854
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Entity Type | Organization
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Legal Business Name | GRADAM MEN'S HEALTH TESTOSTERONE CLINIC LLC
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Dates
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Enumeration Date | 01/20/2025
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Last Update Date | 01/20/2025
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Provider Practice Location Address
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Address Line | 225 NEWMAN AVE
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City | RUMFORD
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State | RI
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Zip | 02916-1218
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Country | US
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Telephone | 401-599-3737
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Fax | 401-409-5545
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Provider Business Mailing Address
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Address Line | 225 NEWMAN AVE
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City | RUMFORD
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State | RI
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Zip | 02916-1218
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Country | US
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Telephone | 401-599-3737
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Fax | 401-409-5545
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. CHARLIE O IMONAH
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Credential | APRN, DNP, FNP
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Telephone | 401-599-3737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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