Provider Demographics
NPI:1164538070
Name:GUTMAN, NED HENRY (MD)
Entity Type:Individual
Prefix:
First Name:NED
Middle Name:HENRY
Last Name:GUTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-1414
Mailing Address - Country:US
Mailing Address - Phone:401-606-1004
Mailing Address - Fax:401-606-1153
Practice Address - Street 1:407 EAST AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-5290
Practice Address - Country:US
Practice Address - Phone:401-475-2505
Practice Address - Fax:401-475-2526
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA81521207RC0000X
RIMD08185207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7004271Medicaid
RI7004271Medicaid