Healthcare Provider Details

I. General information

NPI: 1205942562
Provider Name (Legal Business Name): CATHERINE BREEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 CHALKSTONE AVE PATHOLOGY DEPARTMENT
PROVIDENCE RI
02908-4728
US

IV. Provider business mailing address

825 CHALKSTONE AVE PATHOLOGY DEPARTMENT
PROVIDENCE RI
02908-4728
US

V. Phone/Fax

Practice location:
  • Phone: 401-456-2162
  • Fax: 401-456-2131
Mailing address:
  • Phone: 401-456-2162
  • Fax: 401-456-2131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberMD11646
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD11646
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: