1407265390 NPI number — GREENWICH MEDICAL ASSOCIATES INC

Table of content: (NPI 1407265390)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407265390 NPI number — GREENWICH MEDICAL ASSOCIATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREENWICH MEDICAL ASSOCIATES 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:
1407265390
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1805 DIVISION RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST GREENWICH
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02818-1223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-886-9700
Provider Business Mailing Address Fax Number:
401-884-4235

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1351 S COUNTY TRL
Provider Second Line Business Practice Location Address:
SUITE 215
Provider Business Practice Location Address City Name:
EAST GREENWICH
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02818-5105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-886-9700
Provider Business Practice Location Address Fax Number:
401-884-4235
Provider Enumeration Date:
08/05/2014

Additional Information

Authorized Official

Authorized Official Last Name:
KHAN
Authorized Official First Name:
SHAHID
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
401-886-9700

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MD10893 , 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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