Basic Information
| Provider Information | |||||||||
| NPI: | 1437123403 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | MARY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 825 CHALKSTONE AVE | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029084728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014562000 | ||||||||
| FaxNumber: | 4017513985 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 SMITH ST | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 02908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014562000 | ||||||||
| FaxNumber: | 4017513985 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2006 | ||||||||
| LastUpdateDate: | 02/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | MD11915 | RI | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 174400000X | MD11915 | RI | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 31001-7 | 01 | RI | BLUE CROSS OF RI | OTHER | 7058083 | 05 | RI | MEDICAID | 412997 | 01 | RI | BLUE CHIP OF RI | OTHER |