Healthcare Provider Details

I. General information

NPI: 1356308027
Provider Name (Legal Business Name): BRISTOL NEUROLOGY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 HOPE ST
BRISTOL RI
02809-1806
US

IV. Provider business mailing address

10 ORMS ST SUITE 110
PROVIDENCE RI
02904-2228
US

V. Phone/Fax

Practice location:
  • Phone: 401-254-6044
  • Fax: 401-254-0417
Mailing address:
  • Phone: 401-453-0666
  • Fax: 410-453-9619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: SUSANNE PATRICK-MACKINNON
Title or Position: OWNER
Credential: MD
Phone: 401-254-6055