Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MD10812 | RI |
NPI | 1063466621 |
---|---|
Provider Name | Dr. Gladys Telang |
First Address | Providence, RI 02903-4923 |
Second Address | Providence, RI 02903-4923 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 10/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
709004108 | GROUP MEDICARE (01) | RI |
710000523 | (05) | RI |
9025522 | (05) | RI |
F09426 | (02) | RI |