Healthcare Provider Details

I. General information

NPI: 1760668487
Provider Name (Legal Business Name): BRIAN D CILLEY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2008
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 KENYON AVE
WAKEFIELD RI
02879-4239
US

IV. Provider business mailing address

50 MAUDE ST
PROVIDENCE RI
02908-4325
US

V. Phone/Fax

Practice location:
  • Phone: 401-782-8000
  • Fax:
Mailing address:
  • Phone: 508-973-2000
  • Fax: 508-973-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number243666
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number243666
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberDO00678
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: