Provider Demographics
NPI:1881039352
Name:TARABULSI, GOFRAN K (MD)
Entity Type:Individual
Prefix:DR
First Name:GOFRAN
Middle Name:K
Last Name:TARABULSI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:101 DUDLEY STREET
Mailing Address - Street 2:SUITE 3352
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-2499
Mailing Address - Country:US
Mailing Address - Phone:401-274-1122
Mailing Address - Fax:401-453-7658
Practice Address - Street 1:101 DUDLEY STREET
Practice Address - Street 2:SUITE 3352
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905
Practice Address - Country:US
Practice Address - Phone:401-274-1122
Practice Address - Fax:401-453-7658
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD15476207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program