Provider Demographics
NPI:1881600153
Name:TARNOFF, GERALD MARK (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:MARK
Last Name:TARNOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 VETERANS MEMORIAL PARKWAY
Mailing Address - Street 2:BRADLEY HOSPITAL
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02915
Mailing Address - Country:US
Mailing Address - Phone:401-432-1000
Mailing Address - Fax:401-432-1506
Practice Address - Street 1:1011 VETERANS MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-5061
Practice Address - Country:US
Practice Address - Phone:401-432-1000
Practice Address - Fax:401-432-1506
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD077822084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1104801349OtherBUTLER HOSPITAL NPI
RI1093831646OtherBUTLER HOSPITAL PROFESSIONAL BILLING OFFICE
RI25397-2OtherBLUE CROSS
RI15-58434OtherUNITED BEHAVIORAL HEALTH
RI7001761Medicaid
RI203937OtherBLUE CHIP
RI7001761Medicaid
RI1104801349OtherBUTLER HOSPITAL NPI