# GRADAM MEN'S HEALTH TESTOSTERONE CLINIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Gradam Dispatching Services LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083425854
- **Authorized official:** DR. CHARLIE O IMONAH APRN, DNP, FNP (MEDICAL DIRECTOR)
- **Authorized official phone:** (401) 599-3737

## Contact information

- **Practice address:** 225 NEWMAN AVE, RUMFORD, RI 02916-1218
- **Practice address phone:** (401) 599-3737
- **Practice address fax:** (401) 409-5545
- **Mailing address:** 225 NEWMAN AVE, RUMFORD, RI 02916-1218
- **Mailing address phone:** (401) 599-3737
- **Mailing address fax:** (401) 409-5545

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 01/20/2025
- **Last updated:** 01/20/2025