Provider Demographics
NPI:1023009404
Name:BRASCH, PETER C (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:C
Last Name:BRASCH
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 1:1 THURBER BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02917-1826
Mailing Address - Country:US
Mailing Address - Phone:401-349-5360
Mailing Address - Fax:401-349-5270
Practice Address - Street 1:1 THURBER BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02917-1826
Practice Address - Country:US
Practice Address - Phone:401-349-5360
Practice Address - Fax:401-349-5270
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD07721207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F06680Medicare UPIN
007001863Medicare PIN