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Organization

BROADWAY OB GYN LLP

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. BETHANY R GARDNER (PRACTICE ADMINISTRATOR)
(401) 272-1550
Entity
Organization

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
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
Primary
8926
RI

Other

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
Enumeration date
04/18/2007
Last updated
08/22/2020
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