Provider Demographics
NPI:1124520952
Name:BRENNAN, MARIA CHRISTINE BOTSKO (PA-C)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:CHRISTINE BOTSKO
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:CHRISTINE
Other - Last Name:BOTKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1526 ATWOOD AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-3289
Mailing Address - Country:US
Mailing Address - Phone:401-404-2975
Mailing Address - Fax:401-404-2976
Practice Address - Street 1:1526 ATWOOD AVE STE 220
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-3289
Practice Address - Country:US
Practice Address - Phone:401-404-2975
Practice Address - Fax:401-404-2976
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA01024363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant