1164709739 NPI number — MRS. REBECCA JEANNE GABOURY M.E.D

Table of content: MRS. REBECCA JEANNE GABOURY M.E.D (NPI 1164709739)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164709739 NPI number — MRS. REBECCA JEANNE GABOURY M.E.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GABOURY
Provider First Name:
REBECCA
Provider Middle Name:
JEANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.E.D
Provider Gender Code:
F

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:
1164709739
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
556 DOUGLAS PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH SMITHFIELD
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02896-9578
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
640 GEORGE WASHINGTON HIGHWAY
Provider Second Line Business Practice Location Address:
BUILDING B SUITE 200
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02865
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-495-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/10/2011

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: 235500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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