Provider Demographics
NPI:1467630244
Name:ANDRADE, GREGORY SCOTT
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:SCOTT
Last Name:ANDRADE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 ROBIN HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:WEST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02817-2133
Mailing Address - Country:US
Mailing Address - Phone:401-392-1354
Mailing Address - Fax:
Practice Address - Street 1:294 ROBIN HOLLOW RD
Practice Address - Street 2:
Practice Address - City:WEST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02817-2133
Practice Address - Country:US
Practice Address - Phone:401-392-1354
Practice Address - Fax:401-722-5916
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-04
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIADC00039261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care