Provider Demographics
NPI:1184713646
Name:EGP INC
Entity type:Organization
Organization Name:EGP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DICOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-884-8900
Mailing Address - Street 1:1377 S COUNTY TRL
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-5082
Mailing Address - Country:US
Mailing Address - Phone:401-884-8900
Mailing Address - Fax:401-884-9199
Practice Address - Street 1:1377 S COUNTY TRL
Practice Address - Street 2:SUITE 2B
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-5082
Practice Address - Country:US
Practice Address - Phone:401-884-8900
Practice Address - Fax:401-884-9199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty