=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972614733
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GILBERT J ALTONGY MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 11/22/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1002 BROAD STREET
-----------------------------------------------------
City | CENTRAL FALLS
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02863
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-723-9250
-----------------------------------------------------
Fax | 401-728-0301
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 70
-----------------------------------------------------
City | ALBION
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02802-0070
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RI0011X
-----------------------------------------------------
Taxonomy Name | Interventional Cardiology Physician
-----------------------------------------------------
License Number | MD05204
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------