Provider Demographics
NPI:1992791958
Name:ALBANO, BRIAN J (DPM)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:J
Last Name:ALBANO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-2700
Mailing Address - Country:US
Mailing Address - Phone:401-273-0600
Mailing Address - Fax:401-273-0412
Practice Address - Street 1:1075 SMITH ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-2700
Practice Address - Country:US
Practice Address - Phone:401-273-0600
Practice Address - Fax:401-273-0412
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2008-01-14
Deactivation Date:2006-03-30
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
RIDPM00197213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIT53568Medicare UPIN
RI489007201Medicare PIN