Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | MD10597 | RI |
NPI | 1023091949 |
---|---|
Provider Name | Malini C. Gillen |
First Address | Lincoln, RI 02865-1168 |
Second Address | Lincoln, RI 02865-1168 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2005 |
Last Update Date | 19/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9023621 | (05) | RI |
H48353 | (02) | RI |