1326399726 NPI number — EDWARD J GAUTHIER MD INC

Table of content: (NPI 1326399726)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326399726 NPI number — EDWARD J GAUTHIER MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDWARD J GAUTHIER MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1326399726
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8879
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRANSTON
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02920-0879
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-572-3120
Provider Business Mailing Address Fax Number:
401-572-3351

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1332 SMITH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
N PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02911-3303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-273-5277
Provider Business Practice Location Address Fax Number:
401-751-2980
Provider Enumeration Date:
09/25/2012

Additional Information

Authorized Official

Authorized Official Last Name:
DAWSON
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
401-572-3120

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  3421 , 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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