Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0402X | Child Neurologist | 213712 | MA |
Y | 2084N0402X | Child Neurologist | MD11298 | RI |
NPI | 1225065394 |
---|---|
Provider Name | John N Gaitanis |
First Address | Providence, RI 02903-4141 |
Second Address | Providence, RI 02903-4923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H66234 | (02) | RI |
JG49530 | (05) | RI |