Provider Demographics
NPI:1538168117
Name:GACCIONE, DANIEL R (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:R
Last Name:GACCIONE
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 1:101 AIRPORT RD.
Mailing Address - Street 2:
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891
Mailing Address - Country:US
Mailing Address - Phone:401-596-0259
Mailing Address - Fax:401-348-5934
Practice Address - Street 1:101 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891
Practice Address - Country:US
Practice Address - Phone:401-596-0259
Practice Address - Fax:401-348-5934
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD07085207X00000X
CT034988207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI010007085RI02OtherANTHEM BC/BS
0901058OtherUNITED HEALTH
RI22654-7OtherBCBS
2V1386OtherHEALTHNET
CT010034988CT02OtherANTHEM BC/BS
CT200001006Medicare ID - Type Unspecified
2V1386OtherHEALTHNET
CT010034988CT02OtherANTHEM BC/BS