Provider Demographics
NPI:1144221862
Name:DA SILVA, GRACIETTE (PA-C)
Entity Type:Individual
Prefix:
First Name:GRACIETTE
Middle Name:
Last Name:DA SILVA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RANDALL SQ STE 306
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-2751
Mailing Address - Country:US
Mailing Address - Phone:401-751-7546
Mailing Address - Fax:401-751-6888
Practice Address - Street 1:1 RANDALL SQ STE 306
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-2751
Practice Address - Country:US
Practice Address - Phone:401-751-7546
Practice Address - Fax:401-751-6888
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA7524363A00000X, 363AS0400X
RIPA00145363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI401452OtherHARVARD PILGRIM HEALTH
RI03-00134OtherUNITED HEALTH PLAN
RI3804OtherNEIGHBORHOOD HEALTH
RIGD31756Medicaid
RI406469OtherBCHIP
RI007158OtherTUFTS HEALTH PLAN
RI0000030892OtherB/S
RI406469OtherBCHIP