Provider Demographics
NPI:1538200878
Name:JOSEPH R. GAETA, MD
Entity type:Organization
Organization Name:JOSEPH R. GAETA, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DARVEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-521-4086
Mailing Address - Street 1:235 PLAIN ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-3240
Mailing Address - Country:US
Mailing Address - Phone:401-521-4086
Mailing Address - Fax:401-453-1528
Practice Address - Street 1:235 PLAIN ST
Practice Address - Street 2:SUITE 307
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-3240
Practice Address - Country:US
Practice Address - Phone:401-521-4086
Practice Address - Fax:401-453-1528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD 3525207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9025248Medicaid
RIC89931RIMedicare UPIN