Provider Demographics
NPI:1861593733
Name:GIGA MED II, LLC
Entity type:Organization
Organization Name:GIGA MED II, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABENA
Authorized Official - Middle Name:AMOABEA
Authorized Official - Last Name:ADDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-849-0500
Mailing Address - Street 1:62 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-2750
Mailing Address - Country:US
Mailing Address - Phone:401-849-0500
Mailing Address - Fax:401-849-0511
Practice Address - Street 1:62 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-2750
Practice Address - Country:US
Practice Address - Phone:401-849-0500
Practice Address - Fax:401-849-0511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD11019/MD10713207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIGM58646Medicaid
RI=========OtherUNITED HEALTH