Provider Demographics
NPI:1447219811
Name:STRATTON, GUS GREGORY (MD)
Entity Type:Individual
Prefix:DR
First Name:GUS
Middle Name:GREGORY
Last Name:STRATTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:105 SOCKANOSSET CROSS RD
Mailing Address - Street 2:SUITE 314
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-5560
Mailing Address - Country:US
Mailing Address - Phone:401-946-8100
Mailing Address - Fax:401-946-8102
Practice Address - Street 1:105 SOCKANOSSET CROSS RD
Practice Address - Street 2:SUITE 314
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-5560
Practice Address - Country:US
Practice Address - Phone:401-946-8100
Practice Address - Fax:401-946-8102
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI 071302084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI139001035Medicare ID - Type Unspecified
RIC90355Medicare UPIN