Provider Demographics
NPI:1255355111
Name:GUTMAN, DEBORAH (MD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:GUTMAN
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:PO BOX 9484
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02940-9484
Mailing Address - Country:US
Mailing Address - Phone:401-854-2500
Mailing Address - Fax:401-854-2519
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-519-1604
Practice Address - Fax:401-272-1307
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD10802207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI12/14/2006OtherNHPRI
RI410800OtherBCBSRI
MA2003597Medicaid
MA12/29/2008OtherTUFTS HEALTH PLAN
RI1255355111OtherNPI
RI7009777Medicaid
RI939025129OtherRI MEDICARE GROUP NUMBER
RIP00048520OtherRAILROAD MEDICARE
RI1255355111OtherNPI
RI939025129OtherRI MEDICARE GROUP NUMBER