Provider Demographics
NPI:1720180367
Name:GIOVETTI, MARY LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:LOUISE
Last Name:GIOVETTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 THE BRIDGEWAY
Mailing Address - Street 2:NORTHWEST HEALTH CENTER
Mailing Address - City:PASCOAG
Mailing Address - State:RI
Mailing Address - Zip Code:02859
Mailing Address - Country:US
Mailing Address - Phone:401-568-7661
Mailing Address - Fax:401-568-7949
Practice Address - Street 1:36 BRIDGE WAY
Practice Address - Street 2:
Practice Address - City:PASCOAG
Practice Address - State:RI
Practice Address - Zip Code:02859-3131
Practice Address - Country:US
Practice Address - Phone:401-568-7661
Practice Address - Fax:401-568-7949
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI7491207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI004121OtherBCHIP
RI0100391OtherUNITED HEALTH
RI27082OtherBCBS
RI411814OtherMEDICARE GROUP NUMBER
RI7001348Medicaid
RIAA34892OtherHARVARD PILGRIM
RI01150OtherNEIGHBORHOOD HEALTH
RI0100391OtherUNITED HEALTH
RI27082OtherBCBS
RI709004025Medicare Oscar/Certification