Provider Demographics
NPI:1437123403
Name:BROWN, REBECCA MARY (MD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARY
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 CHALKSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-4728
Mailing Address - Country:US
Mailing Address - Phone:401-456-2000
Mailing Address - Fax:401-751-3985
Practice Address - Street 1:700 SMITH ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908
Practice Address - Country:US
Practice Address - Phone:401-456-2000
Practice Address - Fax:401-751-3985
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD11915207RG0300X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI31001-7OtherBLUE CROSS OF RI
RI7058083Medicaid
RI412997OtherBLUE CHIP OF RI
RI31001-7OtherBLUE CROSS OF RI
RI412997OtherBLUE CHIP OF RI