1285610600 NPI number — DR. MANOJ KUMAR GARG D.O.

Table of content: DR. MANOJ KUMAR GARG D.O. (NPI 1285610600)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285610600 NPI number — DR. MANOJ KUMAR GARG D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARG
Provider First Name:
MANOJ
Provider Middle Name:
KUMAR
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1285610600
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 DAVOL SQ
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02903-4754
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-421-4000
Provider Business Mailing Address Fax Number:
401-272-1456

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 WARREN AVE
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
EAST PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02914-1430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-383-9662
Provider Business Practice Location Address Fax Number:
401-383-6526
Provider Enumeration Date:
12/17/2005

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: 207Q00000X , with the licence number:  DO 00528 , 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)

  • Identifier: 7009041 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 05-0483739 . This is a "TAX ID" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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