1073136636 NPI number — DR. NICHOLAS PAXSON GABINET MD

Table of content: DR. NICHOLAS PAXSON GABINET MD (NPI 1073136636)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073136636 NPI number — DR. NICHOLAS PAXSON GABINET MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GABINET
Provider First Name:
NICHOLAS
Provider Middle Name:
PAXSON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073136636
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/12/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
151 NARRAGANSETT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JAMESTOWN
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02835-1147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-651-5552
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19 FRIENDSHIP ST UNIT 240
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWPORT
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02840-2200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-619-3930
Provider Business Practice Location Address Fax Number:
401-619-3932
Provider Enumeration Date:
05/18/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  LP04963 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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