Provider Demographics
NPI:1194816785
Name:GIGA MED I LLC
Entity Type:Organization
Organization Name:GIGA MED I LLC
Other - Org Name:GIGA MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THEOPHILUS
Authorized Official - Middle Name:VINCENT, NII MOI
Authorized Official - Last Name:ADDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-985-1955
Mailing Address - Street 1:606 TARKILN HILL RD
Mailing Address - Street 2:GIGA MEDICAL
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02745-5556
Mailing Address - Country:US
Mailing Address - Phone:508-985-1955
Mailing Address - Fax:508-985-1977
Practice Address - Street 1:606 TARKILN HILL RD
Practice Address - Street 2:GIGA MEDICAL
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02745-5556
Practice Address - Country:US
Practice Address - Phone:508-985-1955
Practice Address - Fax:508-985-1977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216068/ 223212207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9760300Medicaid
MA9760300Medicaid