Provider Demographics
NPI:1902896939
Name:DUBEL, GREGORY J (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:J
Last Name:DUBEL
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 1:125 METRO CENTER BLVD STE 2000
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1785
Mailing Address - Country:US
Mailing Address - Phone:401-432-2520
Mailing Address - Fax:401-921-9212
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:401-444-5174
Practice Address - Fax:401-921-9212
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD093602085R0202X, 2085R0204X
MA2058032085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
009360OtherBLUE SHIELD
405085OtherBLUE CHIP
300100211OtherRAILROAD MEDICARE
007007231OtherHOSPITAL PIN
009360OtherTUFTS
MA0162221Medicaid
RI7007223OtherMEDICAL ASSISTANCE
0162221OtherHEALTHY START
720082001OtherCIGNA
000000001988OtherNHPRI
1600025OtherUNITED HEALTH PLANS
241363OtherRIHPILGRIM
405085OtherBLUE CHIP