# BROADWAY OB GYN LLP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831315548
- **Authorized official:** MRS. BETHANY R GARDNER (PRACTICE ADMINISTRATOR)
- **Authorized official phone:** (401) 272-1550

## Contact information

- **Practice address:** 695 EDDY ST, SUITE 21, PROVIDENCE, RI 02903-4941
- **Practice address phone:** (401) 272-1550
- **Mailing address:** 695 EDDY ST, SUITE 21, PROVIDENCE, RI 02903-4941
- **Mailing address phone:** (401) 272-1550

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | 03707 | RI | — |
| 207V00000X | Obstetrics & Gynecology Physician | 11231 | RI | — |
| 207V00000X | Obstetrics & Gynecology Physician | 5084 | RI | — |
| 207V00000X | Obstetrics & Gynecology Physician | 6660 | RI | — |
| 207V00000X | Obstetrics & Gynecology Physician | 7662 | RI | — |
| 207V00000X | Obstetrics & Gynecology Physician | 8281 | RI | — |
| 207V00000X | Obstetrics & Gynecology Physician | 8926 | RI | Yes |

## Other

- **Enumeration date:** 04/18/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 9002167 | — | RI |
| 05 | — | 9020237 | — | RI |
| 05 | — | 9020313 | — | RI |
| 05 | — | FB09430 | — | RI |
| 05 | — | FP09431 | — | RI |
| 05 | — | LC51020 | — | RI |