Provider Demographics
NPI:1659469062
Name:OCEAN STATE NEUROSURGERY, LLC
Entity Type:Organization
Organization Name:OCEAN STATE NEUROSURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE/PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUGLIELMO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-739-4988
Mailing Address - Street 1:176 TOLL GATE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4482
Mailing Address - Country:US
Mailing Address - Phone:401-739-4988
Mailing Address - Fax:401-739-4739
Practice Address - Street 1:176 TOLL GATE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4482
Practice Address - Country:US
Practice Address - Phone:401-739-4988
Practice Address - Fax:401-739-4739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD9112207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9004550Medicaid
RIH09842Medicare UPIN
RI149004550Medicare ID - Type Unspecified