Healthcare Provider Details

I. General information

NPI: 1023009404
Provider Name (Legal Business Name): PETER C BRASCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 03/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 THURBER BLVD SUITE B
SMITHFIELD RI
02917-1826
US

IV. Provider business mailing address

1 THURBER BLVD SUITE B
SMITHFIELD RI
02917-1826
US

V. Phone/Fax

Practice location:
  • Phone: 401-349-5360
  • Fax: 401-349-5270
Mailing address:
  • Phone: 401-349-5360
  • Fax: 401-349-5270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD07721
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: