Healthcare Provider Details

I. General information

NPI: 1053443911
Provider Name (Legal Business Name): CHAD BROWN HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285A CHAD BROWN ST
PROVIDENCE RI
02908-3102
US

IV. Provider business mailing address

10 ORMS ST STE 110
PROVIDENCE RI
02904-7814
US

V. Phone/Fax

Practice location:
  • Phone: 401-274-6339
  • Fax: 401-453-6290
Mailing address:
  • Phone: 401-453-0666
  • Fax: 401-453-9619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NANCY CLANCY
Title or Position: FINANCE
Credential:
Phone: 401-274-6339