Provider Demographics
NPI:1720390487
Name:FESSENDEN, GREGORY P (MBA, MS, LAC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:P
Last Name:FESSENDEN
Suffix:
Gender:M
Credentials:MBA, MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-2242
Mailing Address - Country:US
Mailing Address - Phone:917-882-6262
Mailing Address - Fax:
Practice Address - Street 1:1 SUMMER ST
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-2242
Practice Address - Country:US
Practice Address - Phone:917-882-6262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-10
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDA00346171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist