Provider Demographics
NPI:1740295328
Name:GERARD G. GAGNE, JR. MD GENERAL ADULT PSYCHIATRY
Entity type:Organization
Organization Name:GERARD G. GAGNE, JR. MD GENERAL ADULT PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:GAGNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-431-1500
Mailing Address - Street 1:250 WAMPANOAG TRL
Mailing Address - Street 2:SUITE 303
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-2218
Mailing Address - Country:US
Mailing Address - Phone:401-431-1500
Mailing Address - Fax:401-438-1605
Practice Address - Street 1:250 WAMPANOAG TRL
Practice Address - Street 2:SUITE 303
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-2218
Practice Address - Country:US
Practice Address - Phone:401-431-1500
Practice Address - Fax:401-438-1605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty