MEDICARE: DR. GERALD A COLVIN DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	262469	NY
2	207RH0003X	Hematology & Oncology Physician	DO00536	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417954199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERALD A COLVIN DO

Provider Business Mailing Address
First Line	:	PO BOX 229
Second Line	:
City	:	WAKEFIELD
State	:	RI
Zip	:	02880-0229
Country	:	US
Telephone Number	:	401-783-6670
Fax Number	:	401-789-4990

Provider Business Practice Location Address
First Line	:	100 KENYON AVE
Second Line	:
City	:	WAKEFIELD
State	:	RI
Zip	:	02879-4216
Country	:	US
Telephone Number	:	401-783-6670
Fax Number	:	401-789-4990

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	09/09/2025

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