Provider Demographics
NPI:1467446880
Name:OEHLER, GREGG E (PA)
Entity Type:Individual
Prefix:
First Name:GREGG
Middle Name:E
Last Name:OEHLER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 BALD HILL RD
Mailing Address - Street 2:SUITE 520
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1617
Mailing Address - Country:US
Mailing Address - Phone:401-793-8520
Mailing Address - Fax:401-793-8527
Practice Address - Street 1:400 BALD HILL RD
Practice Address - Street 2:SUITE 520
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1617
Practice Address - Country:US
Practice Address - Phone:401-793-8520
Practice Address - Fax:401-793-8527
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA000046363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIS66018Medicare UPIN
RI007009858Medicare PIN