Provider Demographics
NPI:1063466621
Name:TELANG, GLADYS (MD)
Entity Type:Individual
Prefix:DR
First Name:GLADYS
Middle Name:
Last Name:TELANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:593 EDDY ST
Mailing Address - Street 2:APC 10
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4923
Mailing Address - Country:US
Mailing Address - Phone:401-444-7959
Mailing Address - Fax:401-444-7144
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:APC 10
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-444-7959
Practice Address - Fax:401-444-7144
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD10812207ZD0900X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI710000523Medicaid
RI9025522Medicaid
RI709004108OtherGROUP MEDICARE
RI007057620Medicare PIN