Provider Demographics
NPI:1407265390
Name:GREENWICH MEDICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:GREENWICH MEDICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHID
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-886-9700
Mailing Address - Street 1:1805 DIVISION RD
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-1223
Mailing Address - Country:US
Mailing Address - Phone:401-886-9700
Mailing Address - Fax:401-884-4235
Practice Address - Street 1:1351 S COUNTY TRL
Practice Address - Street 2:SUITE 215
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-5105
Practice Address - Country:US
Practice Address - Phone:401-886-9700
Practice Address - Fax:401-884-4235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-05
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD10893207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIH63830Medicare UPIN