Provider Demographics
NPI:1063433530
Name:ABBOTT, BRIAN G (MD)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:G
Last Name:ABBOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1377 S COUNTY TRL
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-5082
Mailing Address - Country:US
Mailing Address - Phone:401-886-7590
Mailing Address - Fax:401-886-7571
Practice Address - Street 1:1377 S COUNTY TRL
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-5082
Practice Address - Country:US
Practice Address - Phone:401-886-7590
Practice Address - Fax:401-886-7571
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD11486207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9003694Medicaid
RIG85744Medicare UPIN
RI709003694Medicare ID - Type Unspecified