=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588642789
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANNE CUSHING-BRESCIA, MD, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 SMITHFIELD AVE
-----------------------------------------------------
City | PAWTUCKET
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02860-3474
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-725-0900
-----------------------------------------------------
Fax | 401-725-6014
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 SMITHFIELD AVE
-----------------------------------------------------
City | PAWTUCKET
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02860-3474
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-725-0900
-----------------------------------------------------
Fax | 401-725-6014
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ANNE CUSHING-BRESCIA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 401-725-0900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | MD07939
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------