Individual
GHULAM MUSTAFA SURTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
345 BLACKSTONE BLVD, PROVIDENCE, RI 02906-4800
(401) 455-6200
(401) 455-6309
Mailing address
345 BLACKSTONE BLVD, PROVIDENCE, RI 02906-4800
(401) 455-6200
(401) 455-6309
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD09937
RI
2084P0805X
Geriatric Psychiatry Physician
MD09937
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007008181
MEDICARE ID-TYPE UNSPECIFIED
RI
05
—
02246624
—
NY
01
—
1093831646
BUTLER HOSPITAL PROFESSIONAL BILLING OFFICE
RI
01
—
1104801349
BUTLER HOSPITAL NPI
RI
01
—
15-43150
UNITED BEHAVIORAL HEALTH
RI
01
—
23998-5
BLUE CROSS
RI
01
—
406629
BLUE CHIP
RI
05
—
GS29847
—
RI
01
—
P00362436
MEDICARE RAILROAD
RI
Enumeration date
07/07/2005
Last updated
02/28/2023
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