Healthcare Provider Details

I. General information

NPI: 1437123403
Provider Name (Legal Business Name): REBECCA MARY BROWN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 02/10/2020
Certification Date: 02/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SMITH ST
PROVIDENCE RI
02908
US

IV. Provider business mailing address

825 CHALKSTONE AVE
PROVIDENCE RI
02908-4728
US

V. Phone/Fax

Practice location:
  • Phone: 401-456-2000
  • Fax: 401-751-3985
Mailing address:
  • Phone: 401-456-2000
  • Fax: 401-751-3985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD11915
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberMD11915
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: