Provider Demographics
NPI:1356323174
Name:GIL, HOLLY C (MD)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:C
Last Name:GIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 METRO CENTER BLVD STE 2000
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1785
Mailing Address - Country:US
Mailing Address - Phone:401-432-2520
Mailing Address - Fax:401-453-8220
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-444-5174
Practice Address - Fax:401-453-8220
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2199652085R0202X
RI113732085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
9360453OtherPHHCS
CT003123776OtherMED ASSISTANCE
RI9003515OtherMEDICAL ASSISTANCE
1988OtherNHPRI
AA16957OtherRIHPILGRIM
411926OtherBLUECHIP
0308550OtherCIGNA
MA2083523Medicaid
3707992OtherAETNA
9360453OtherPHHCS
3707992OtherAETNA
RI9003515OtherMEDICAL ASSISTANCE