Individual
MR. MARK RYAN GAUVIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, MSPAS, RD, PA-C
Contact information
Practice address
1360 W MAIN RD, MIDDLETOWN, RI 02842-6301
(401) 606-3111
Mailing address
1360 W MAIN RD, MIDDLETOWN, RI 02842-6301
(401) 606-3111
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
LDN00892
RI
363A00000X
Physician Assistant
Primary
PA01375
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110178471A
MASSHEALTH
MA
Enumeration date
01/18/2017
Last updated
02/07/2025
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