Basic Information
Provider Information | |||||||||
NPI: | 1073549259 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ANDRIULLI | ||||||||
FirstName: | GERARDO | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2 OLD COUNTY RD | ||||||||
Address2: |   | ||||||||
City: | BARRINGTON | ||||||||
State: | RI | ||||||||
PostalCode: | 028061600 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4012461195 | ||||||||
FaxNumber: | 4012461985 | ||||||||
Practice Location | |||||||||
Address1: | 2 OLD COUNTY RD | ||||||||
Address2: |   | ||||||||
City: | BARRINGTON | ||||||||
State: | RI | ||||||||
PostalCode: | 028061602 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4012461195 | ||||||||
FaxNumber: | 4012461985 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/23/2006 | ||||||||
LastUpdateDate: | 02/24/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | MD07419 | RI | Y |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
ID | Type | State | Issuer | Description | 15-16207 | 01 | RI | UNITED BEHAVIORAL HEALTH | OTHER | 406535 | 01 | RI | BLUE CHIP | OTHER | GA33826 | 05 | RI |   | MEDICAID | 260047476 | 01 | RI | MEDICARE R R | OTHER | 30836-8 | 01 | RI | BLUE CROSS | OTHER |