| Eastside Neurology, Inc. | |
|
450 Veterans Memorial Pkwy Building 11 East Providence RI 02914-5300 | |
| (401) 431-1860 | |
| (401) 435-0328 |
| Full Name | Eastside Neurology, Inc. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 450 Veterans Memorial Pkwy, East Providence, Rhode Island |
| Authorized Official Name and Position | Norman Mervyn Gordon (PRESIDENT) |
| Authorized Official Contact | 4014311860 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eastside Neurology, Inc. 450 Veterans Memorial Pkwy Building 11 East Providence RI 02914-5300 Ph: (401) 431-1860 | Eastside Neurology, Inc. 450 Veterans Memorial Pkwy Building 11 East Providence RI 02914-5300 Ph: (401) 431-1860 |
| NPI Number | 1407079643 |
|---|---|
| Provider Enumeration Date | 04/10/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 1658446695 |
|---|---|
| Medicare Enrollment ID | O20080826000446 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407079643 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 7343 (Rhode Island) | Primary |
| Provider Name | Norman M Gordon |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1467481648 PECOS PAC ID: 3173698123 Enrollment ID: I20080826000589 |
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