Provider Demographics
NPI:1750968731
Name:VAN VERDEGHEM, BRIANA (MD)
Entity type:Individual
Prefix:
First Name:BRIANA
Middle Name:
Last Name:VAN VERDEGHEM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:117 ELLENFIELD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-4541
Mailing Address - Country:US
Mailing Address - Phone:401-444-6779
Mailing Address - Fax:401-444-6912
Practice Address - Street 1:19 FRIENDSHIP ST UNIT 340
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-2200
Practice Address - Country:US
Practice Address - Phone:401-845-4340
Practice Address - Fax:401-845-4349
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD205722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry