Provider Demographics
NPI:1003855339
Name:LOCKHART, GREGORY R (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:R
Last Name:LOCKHART
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 9484
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02940-9484
Mailing Address - Country:US
Mailing Address - Phone:401-854-2500
Mailing Address - Fax:401-854-2519
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:CLAVERICK 2
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-444-4000
Practice Address - Fax:401-427-7795
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD08011207PP0204X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI04/15/2009OtherUNITED HEALTHCARE
RI1/11/2007OtherNHPRI
RI3184757OtherMA MEDICAID
RI1003855339OtherNPI
410745OtherBLUECHIP
MA12/29/2008OtherTUFTS HEALTH PLAN
RI7003619Medicaid
RI939025129OtherRI MEDICARE GROUP NUMBER
RI04/15/2009OtherUNITED HEALTHCARE
RI939025129OtherRI MEDICARE GROUP NUMBER