Provider Demographics
NPI:1700050879
Name:SMITH, JEANETTE GABRIELLA (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:GABRIELLA
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 VIRGINIA AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-4406
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:375 WAMPANOAG TRL
Practice Address - Street 2:SUITE 202A
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-2212
Practice Address - Country:US
Practice Address - Phone:401-649-4030
Practice Address - Fax:401-649-4031
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD00000207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology