Gwenn Maria Vittimberga, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

MD 7158 Issued in RI

Practice address

1180 Hope St
Bristol, RI 02809-1126

Phone

(401) 253-8900

Fax

(401) 254-1093

NPI assigned

Aug 2, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Enrolled in RI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Medical Associates of Ri Inc

  • Internal Medicine Physician
  • Bristol, RI
  • NPI 1538161161

  Dermatology

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1122940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1201046400000",
    "number": "1891796702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1180 HOPE ST",
            "city": "BRISTOL",
            "state": "RI",
            "postal_code": "028091126",
            "telephone_number": "401-253-8900",
            "fax_number": "401-254-1093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1180 HOPE ST",
            "city": "BRISTOL",
            "state": "RI",
            "postal_code": "028091126",
            "telephone_number": "401-253-8900",
            "fax_number": "401-254-1093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VITTIMBERGA",
        "first_name": "GWENN",
        "middle_name": "MARIA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-02",
        "last_updated": "2008-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "RI",
            "license": "MD 7158",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "03-00134",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCHIP",
            "identifier": "201972",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM HEALTH",
            "identifier": "401452",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS",
            "identifier": "007158",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "B/S",
            "identifier": "20074-3",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEIGHBORHOOD  HEALTH",
            "identifier": "3804",
            "state": "RI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9020074",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Town of Bristol (Bristol Fire Department)
• Universtiy Urological Associates, Inc.
• Vallee Associates in Psychology
• Carolynn Lee Vallot, LMHC
• Jody Vieira, MSW, LICSW
• Cory Charles Viveiros, ATC
• Daniel Walden, MD
• Kathleen Walden, IBCLC
• Walgreen Co (Rite Aid)
• Walgreen Co (Walgreens #06892)

• Dermatology Physician in Bristol, RI
• Providers in Bristol, RI by specialty
• Dermatology Physician in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.