MEDICARE: ANDREA MERNAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	MD10152	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MD10152	OTHER	RI	LICENSE

General Provider Information

NPI Number	:	1326047218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA MERNAN MD

Provider Business Mailing Address
First Line	:	24 ROSEGARDEN ST
Second Line	:
City	:	WARWICK
State	:	RI
Zip	:	02888-2811
Country	:	US
Telephone Number	:	401-461-8960
Fax Number	:

Provider Business Practice Location Address
First Line	:	530 N MAIN ST
Second Line	:	THE PROVIDENCE CENTER
City	:	PROVIDENCE
State	:	RI
Zip	:	02904-5762
Country	:	US
Telephone Number	:	401-274-7111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	07/08/2007

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