Healthcare Provider Details

I. General information

NPI: 1326047218
Provider Name (Legal Business Name): ANDREA MERNAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 N MAIN ST THE PROVIDENCE CENTER
PROVIDENCE RI
02904-5762
US

IV. Provider business mailing address

24 ROSEGARDEN ST
WARWICK RI
02888-2811
US

V. Phone/Fax

Practice location:
  • Phone: 401-274-7111
  • Fax:
Mailing address:
  • Phone: 401-461-8960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD10152
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: