Provider Demographics
NPI:1356627665
Name:TAITANO, E GENA MAE (PA)
Entity Type:Individual
Prefix:
First Name:E GENA
Middle Name:MAE
Last Name:TAITANO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:GENA
Other - Middle Name:MAE
Other - Last Name:TAITANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:1351 S COUNTY TRL
Mailing Address - Street 2:SUITE 301
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-5105
Mailing Address - Country:US
Mailing Address - Phone:401-398-0860
Mailing Address - Fax:
Practice Address - Street 1:1351 S COUNTY TRL
Practice Address - Street 2:SUITE 301
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-5105
Practice Address - Country:US
Practice Address - Phone:401-398-0860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00331363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical