1407835614 NPI number — DR. GAIL R BROWN MD

Table of content: DR. GAIL R BROWN MD (NPI 1407835614)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407835614 NPI number — DR. GAIL R BROWN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
GAIL
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407835614
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 DAVOL SQ
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02903-4754
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-421-4000
Provider Business Mailing Address Fax Number:
401-272-1456

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 COMMONWEALTH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARWICK
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02886-2778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-732-5437
Provider Business Practice Location Address Fax Number:
401-615-7529
Provider Enumeration Date:
01/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  4301071395 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4303689 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3503905411 . This is a "BLUE CROSS PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4301071395 . This is a "PHYSICIAN LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P110973 . This is a "BLUE CHOICE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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