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General NPI Number Information
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NPI Number | 1740295328
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Entity Type | Organization
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Legal Business Name | GERARD G. GAGNE, JR. MD GENERAL ADULT PSYCHIATRY
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 09/25/2008
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Provider Practice Location Address
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Address Line | 250 WAMPANOAG TRL SUITE 303
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City | RIVERSIDE
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State | RI
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Zip | 02915-2218
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Country | US
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Telephone | 401-431-1500
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Fax | 401-438-1605
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Provider Business Mailing Address
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Address Line | 250 WAMPANOAG TRL SUITE 303
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City | RIVERSIDE
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State | RI
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Zip | 02915-2218
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Country | US
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Telephone | 401-431-1500
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Fax | 401-438-1605
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Authorized Official
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Title or Position | PHYSICIAN, PRESIDENT
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Name | DR. GERARD GEORGE GAGNE
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Credential | MD
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Telephone | 401-431-1500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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