Provider Demographics
NPI:1740366533
Name:MANNA, GAIL (MD)
Entity type:Individual
Prefix:DR
First Name:GAIL
Middle Name:
Last Name:MANNA
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 1:525 TAUNTON AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-1603
Mailing Address - Country:US
Mailing Address - Phone:401-438-3170
Mailing Address - Fax:401-438-3240
Practice Address - Street 1:525 TAUNTON AVE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-1603
Practice Address - Country:US
Practice Address - Phone:401-438-3170
Practice Address - Fax:401-438-3240
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI07476207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7003654Medicaid
RIF18881Medicare UPIN