Healthcare Provider Details

I. General information

NPI: 1124555073
Provider Name (Legal Business Name): STEPHANIE GAIL BRAUNTHAL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 DUDLEY STREET WIH OBSTETRIC AND CONSULTATIVE MEDICINE
PROVIDENCE RI
02905
US

IV. Provider business mailing address

455 TOLL GATE RD PRC AND CREDENTIALING
WARWICK RI
02886-2759
US

V. Phone/Fax

Practice location:
  • Phone: 401-453-7950
  • Fax: 401-453-7748
Mailing address:
  • Phone: 401-273-0641
  • Fax: 401-273-2919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDO01094
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: