Healthcare Provider Details

I. General information

NPI: 1710103536
Provider Name (Legal Business Name): RIMINI A BREAKSTONE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RIMINI VARGHESE MD

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 FRIENDSHIP ST
NEWPORT RI
02840-2209
US

IV. Provider business mailing address

11 FRIENDSHIP ST
NEWPORT RI
02840-2209
US

V. Phone/Fax

Practice location:
  • Phone: 401-846-6400
  • Fax:
Mailing address:
  • Phone: 401-846-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD13321
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD446406
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: