Provider Demographics
NPI:1912000894
Name:DUANE T GOLOMB MD INC
Entity Type:Organization
Organization Name:DUANE T GOLOMB MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:GOLOMB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-822-2772
Mailing Address - Street 1:766 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CORENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816
Mailing Address - Country:US
Mailing Address - Phone:401-822-2772
Mailing Address - Fax:401-821-5260
Practice Address - Street 1:766 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CORENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816
Practice Address - Country:US
Practice Address - Phone:401-822-2772
Practice Address - Fax:401-821-5260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI6442207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7006908Medicaid
RI7006908Medicaid