Provider Demographics
NPI:1316053564
Name:GIBBS, KENDALL A (MD)
Entity type:Individual
Prefix:DR
First Name:KENDALL
Middle Name:A
Last Name:GIBBS
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 1:24 BOSWORTH ST
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-4100
Mailing Address - Country:US
Mailing Address - Phone:401-247-2015
Mailing Address - Fax:
Practice Address - Street 1:24 BOSWORTH ST
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:RI
Practice Address - Zip Code:02806-4100
Practice Address - Country:US
Practice Address - Phone:401-247-2015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD6974207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0000001693OtherBLUE SHIELD OF RI
RI795484OtherTUFTS HEALTH PLAN
RI0800158OtherUNITED HEALTH CARE
RI454425OtherAETNA
RI1055OtherNEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND
RI010018378OtherRAILROAD MEDICARE
RI15459RIHOtherHARVARD PILGRIM HEALTH CARE
RI9001693Medicaid
RI9001693Medicaid
RI1055OtherNEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND
RIC90671Medicare UPIN