Healthcare Provider Details

I. General information

NPI: 1689628653
Provider Name (Legal Business Name): REBECCA MCEACHERN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 04/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 SOCKANOSSET CROSS RD SUITE 318
CRANSTON RI
02920-5560
US

IV. Provider business mailing address

105 SOCKANOSSET CROSS ROAD SUITE 318
CRANSTON RI
02920
US

V. Phone/Fax

Practice location:
  • Phone: 401-434-2058
  • Fax: 401-434-0523
Mailing address:
  • Phone: 401-434-2058
  • Fax: 401-434-0523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number11312
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: