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NPI Code Detail

MEDICARE: MR. MARK RYAN GAUVIN MS, MSPAS, RD, PA-C

MEDICARE: MR. MARK RYAN GAUVIN MS, MSPAS, RD, PA-C
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
1133V00000XRegistered DietitianLDN00892RI
2363A00000XPhysician AssistantPA01375RI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1110178471AOTHERMAMASSHEALTH

General Provider Information

NPI Number : 1801332507
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARK RYAN GAUVIN MS, MSPAS, RD, PA-C
Provider Business Mailing Address
First Line : 1360 W MAIN RD
Second Line :
City : MIDDLETOWN
State : RI
Zip : 02842-6301
Country : US
Telephone Number : 401-606-3111
Fax Number :
Provider Business Practice Location Address
First Line : 1360 W MAIN RD
Second Line :
City : MIDDLETOWN
State : RI
Zip : 02842-6301
Country : US
Telephone Number : 401-606-3111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2017
Last Update Date : 02/07/2025

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