Individual
GWENN MARIA VITTIMBERGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1180 HOPE ST, BRISTOL, RI 02809-1126
(401) 253-8900
(401) 254-1093
Mailing address
1180 HOPE ST, BRISTOL, RI 02809-1126
(401) 253-8900
(401) 254-1093
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
MD 7158
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007158
TUFTS
RI
01
—
03-00134
UNITED HEALTH CARE
RI
01
—
20074-3
B/S
RI
01
—
201972
BCHIP
RI
01
—
3804
NEIGHBORHOOD HEALTH
RI
01
—
401452
HARVARD PILGRIM HEALTH
RI
05
—
9020074
—
RI
Enumeration date
08/02/2005
Last updated
01/23/2008
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