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General NPI Number Information
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NPI Number | 1447382346
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Entity Type | Organization
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Legal Business Name | CHILDREN'S HEALTHCARE, INC
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 12/16/2011
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Provider Practice Location Address
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Address Line | 845 N MAIN ST SUITE 7
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City | PROVIDENCE
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State | RI
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Zip | 02904-5700
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Country | US
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Telephone | 401-383-6776
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Fax | 401-383-7213
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Provider Business Mailing Address
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Address Line | 845 N MAIN ST SUITE 7
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City | PROVIDENCE
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State | RI
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Zip | 02904-5700
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Country | US
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Telephone | 401-383-6776
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Fax | 401-383-7213
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KELVIN D GILLMAN
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Credential | M.D.
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Telephone | 401-383-6776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 8918
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License Number State | RI
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