Individual
STEFAN GRAVENSTEIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
593 EDDY ST, PROVIDENCE, RI 02903
(401) 444-5248
(401) 444-3397
Mailing address
15 LA SALLE SQ, PROVIDENCE, RI 02903-1814
(401) 444-6779
(401) 444-6912
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
MD12353
RI
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
35.120371
OH
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
MD12353
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0075808
—
OH
05
—
1447224191
—
RI
Enumeration date
02/16/2006
Last updated
03/06/2026
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