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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
593 EDDY ST, PROVIDENCE, RI 02903-4923
(401) 444-4000
Mailing address
15 LA SALLE SQ, PROVIDENCE, RI 02903-1814
(401) 444-6779
(401) 444-6912

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
08/04/2026
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