Provider Demographics
NPI:1508841081
Name:SADOVNIKOFF, GREGORY (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:SADOVNIKOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 BAY SPRING AVE
Mailing Address - Street 2:UNIT A1
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-1384
Mailing Address - Country:US
Mailing Address - Phone:401-289-2961
Mailing Address - Fax:
Practice Address - Street 1:60 BAY SPRING AVE
Practice Address - Street 2:UNIT A1
Practice Address - City:BARRINGTON
Practice Address - State:RI
Practice Address - Zip Code:02806-1384
Practice Address - Country:US
Practice Address - Phone:401-289-2961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA160319207Q00000X
RIMD10134207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIMD10134OtherMEDICAL LICENSE
I08039Medicare UPIN
089003463Medicare ID - Type Unspecified