Basic Information
Provider Information | |||||||||
NPI: | 1356323174 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GIL | ||||||||
FirstName: | HOLLY | ||||||||
MiddleName: | C | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 125 METRO CENTER BLVD STE 2000 | ||||||||
Address2: |   | ||||||||
City: | WARWICK | ||||||||
State: | RI | ||||||||
PostalCode: | 028861785 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4014322520 | ||||||||
FaxNumber: | 4014538220 | ||||||||
Practice Location | |||||||||
Address1: | 593 EDDY ST | ||||||||
Address2: |   | ||||||||
City: | PROVIDENCE | ||||||||
State: | RI | ||||||||
PostalCode: | 029034923 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4014445174 | ||||||||
FaxNumber: | 4014538220 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/17/2005 | ||||||||
LastUpdateDate: | 07/27/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/27/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 219965 | MA | N |   | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 11373 | RI | Y |   | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
ID | Type | State | Issuer | Description | 9360453 | 01 |   | PHHCS | OTHER | 003123776 | 01 | CT | MED ASSISTANCE | OTHER | 9003515 | 01 | RI | MEDICAL ASSISTANCE | OTHER | 1988 | 01 |   | NHPRI | OTHER | AA16957 | 01 |   | RIHPILGRIM | OTHER | 411926 | 01 |   | BLUECHIP | OTHER | 0308550 | 01 |   | CIGNA | OTHER | 2083523 | 05 | MA |   | MEDICAID | 3707992 | 01 |   | AETNA | OTHER |