Provider Demographics
NPI:1285620138
Name:AUSTIN, GREGORY JAMES (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:JAMES
Last Name:AUSTIN
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 1:725 RESERVOIR AVE
Mailing Address - Street 2:#101
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-4448
Mailing Address - Country:US
Mailing Address - Phone:401-944-3800
Mailing Address - Fax:401-944-1342
Practice Address - Street 1:725 RESERVOIR AVE
Practice Address - Street 2:#101
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-4448
Practice Address - Country:US
Practice Address - Phone:401-944-3800
Practice Address - Fax:401-944-1342
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD07050207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1285620138OtherDURABLE
RI32154-5OtherRI BLUE CROSS
RI7000832Medicaid
RI200859OtherBLUE CHIP
RI7000832Medicaid
RI32154-5OtherRI BLUE CROSS