Provider Demographics
NPI:1831173301
Name:MEDICAL & RENAL ASSO INC
Entity type:Organization
Organization Name:MEDICAL & RENAL ASSO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:OWEN
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:GILMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-739-7380
Mailing Address - Street 1:250 CENTERVILLE RD
Mailing Address - Street 2:WARWICK EXECUTIVE PARK
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4382
Mailing Address - Country:US
Mailing Address - Phone:401-739-7380
Mailing Address - Fax:401-737-7558
Practice Address - Street 1:250 CENTERVILLE RD
Practice Address - Street 2:WARWICK EXECUTIVE PARK
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4382
Practice Address - Country:US
Practice Address - Phone:401-739-7380
Practice Address - Fax:401-737-7558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty