Provider Demographics
NPI:1023091949
Name:GILLEN, MALINI C (MD)
Entity type:Individual
Prefix:
First Name:MALINI
Middle Name:C
Last Name:GILLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MEEHAN LN
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-1413
Mailing Address - Country:US
Mailing Address - Phone:401-658-2525
Mailing Address - Fax:401-658-3031
Practice Address - Street 1:2 MEEHAN LN
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-1413
Practice Address - Country:US
Practice Address - Phone:401-658-2525
Practice Address - Fax:401-658-3031
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD105972080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9023621Medicaid
RIH48353Medicare UPIN
RI0070591172Medicare PIN