Gateway Healthcare, INC
Specialist in Pawtucket, RI. Organization (NPI-2).
NPI number1477583706
StatusActive
Last updated in NPPESAug 22, 2020
Details
- NPI
- 1477583706
- Entity type
- Organization (NPI-2)
- Legal business name
- Gateway Healthcare, INC
- Organization subpart
- No
- Enumeration date
- Jul 3, 2006
- Last updated
- Aug 22, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 174400000X | Specialist | MD100002 | RI | Yes |
Practice location
249 Roosevelt AveSte 205
Pawtucket, RI 02860-2134
Phone 401-724-8400 · Fax 401-365-1100
Mailing address
249 Roosevelt AveSte 205
Pawtucket, RI 02860-2134
Phone 401-724-8400 · Fax 401-365-1100
Authorized official
Pedro Tactacan
Cred Coordinator
4017248400
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