Provider Demographics
NPI:1104890813
Name:NAU, GERARD J (MD,PHD)
Entity type:Individual
Prefix:
First Name:GERARD
Middle Name:J
Last Name:NAU
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:593 EDDY ST
Mailing Address - Street 2:RHODE ISLAND HOSPITAL - ALDRICH 722
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4923
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1125 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5739
Practice Address - Country:US
Practice Address - Phone:401-793-4020
Practice Address - Fax:401-793-7401
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD421845174400000X
RIMD14543207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG45341Medicare UPIN
PA070524EXAMedicare ID - Type Unspecified