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General NPI Number Information
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NPI Number | 1720018062
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Entity Type | Organization
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Legal Business Name | GATEWAY HEALTHCARE, INC
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 249 ROOSEVELT AVE STE 205
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City | PAWTUCKET
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State | RI
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Zip | 02860-2134
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Country | US
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Telephone | 401-724-8400
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Fax | 401-365-1100
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Provider Business Mailing Address
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Address Line | 249 ROOSEVELT AVE STE 205
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City | PAWTUCKET
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State | RI
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Zip | 02860-2134
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Country | US
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Telephone | 401-724-8400
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Fax | 401-365-1100
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Authorized Official
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Title or Position | MD
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Name | OLGA SMETKOV
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Credential | MD
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Telephone | 401-724-8400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD11599
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License Number State | RI
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