1871696070 NPI number — DR. MARK BREIDING D.C.

Table of content: DR. MARK BREIDING D.C. (NPI 1871696070)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871696070 NPI number — DR. MARK BREIDING D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BREIDING
Provider First Name:
MARK
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

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:
1871696070
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
38 CRESTON WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02906-2735
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-529-7772
Provider Business Mailing Address Fax Number:
401-886-4506

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5544 POST RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST GREENWICH
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02818-3459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-884-8687
Provider Business Practice Location Address Fax Number:
401-886-4506
Provider Enumeration Date:
09/06/2006

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: 111N00000X , with the licence number:  DCP00427 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 44-00621 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 2534160 . This is a "AETNA" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 26384-1 . This is a "BC/BS OF RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: MULTIPLAN . This is a "P-12007098" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 720116401 . This is a "CIGNA" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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