Provider Demographics
NPI:1427079367
Name:HITCHCOCK, GREGORY CHARLES (EMTC)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:CHARLES
Last Name:HITCHCOCK
Suffix:
Gender:M
Credentials:EMTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 MISHNOCK RD
Mailing Address - Street 2:
Mailing Address - City:WEST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02817-1669
Mailing Address - Country:US
Mailing Address - Phone:401-397-7353
Mailing Address - Fax:401-397-9030
Practice Address - Street 1:166 MISHNOCK RD
Practice Address - Street 2:
Practice Address - City:WEST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02817-1669
Practice Address - Country:US
Practice Address - Phone:401-397-7353
Practice Address - Fax:401-397-9030
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI12054146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0000007822OtherRI BLUE CROSS
RI9007822Medicaid
RIBQ409256OtherRI BLUE CHIP HMO