Basic Information
| Provider Information | |||||||||
| NPI: | 1902896939 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUBEL | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | J | ||||||||
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| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 METRO CENTER BLVD STE 2000 | ||||||||
| Address2: | |||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028861785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014322520 | ||||||||
| FaxNumber: | 4019219212 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 METRO CENTER BLVD STE 2000 | ||||||||
| Address2: | |||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028861785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014322520 | ||||||||
| FaxNumber: | 4019219212 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2005 | ||||||||
| LastUpdateDate: | 04/04/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | MD09360 | RI | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | 09360 | RI | Y | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
ID Information
| ID | Type | State | Issuer | Description | 007007231 | 01 | HOSPITAL PIN | OTHER | 300100211 | 01 | RAILROAD MEDICARE | OTHER | 0162221 | 05 | MA | MEDICAID | 7007223 | 01 | RI | MEDICAL ASSISTANCE | OTHER | 405085 | 01 | BLUE CHIP | OTHER | 009360 | 01 | BLUE SHIELD | OTHER | 0162221 | 01 | HEALTHY START | OTHER | 1600025 | 01 | UNITED HEALTH PLANS | OTHER | 241363 | 01 | RIHPILGRIM | OTHER | 720082001 | 01 | CIGNA | OTHER | 000000001988 | 01 | NHPRI | OTHER | 009360 | 01 | TUFTS | OTHER |