Provider Demographics
NPI:1417954199
Name:COLVIN, GERALD A (DO)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:A
Last Name:COLVIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 KENYON AVE
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-4213
Mailing Address - Country:US
Mailing Address - Phone:401-783-6670
Mailing Address - Fax:401-789-4990
Practice Address - Street 1:85 KENYON AVE
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-4213
Practice Address - Country:US
Practice Address - Phone:401-783-6670
Practice Address - Fax:401-789-4990
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO00536207RH0003X
NY262469207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIGC33721Medicaid
NY007059545Medicare UPIN
RIH17034Medicare UPIN
RIGC33721Medicaid