Provider Demographics
NPI:1073875951
Name:MAC GRORY, BRIAN CORMAC (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:CORMAC
Last Name:MAC GRORY
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Gender:M
Credentials:MD
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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:02905-4513
Mailing Address - Country:US
Mailing Address - Phone:401-444-6779
Mailing Address - Fax:401-444-6912
Practice Address - Street 1:593 EDDY STREET
Practice Address - Street 2:APC 5
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903
Practice Address - Country:US
Practice Address - Phone:401-444-6440
Practice Address - Fax:401-444-6858
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2019-02-06
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Provider Licenses
StateLicense IDTaxonomies
RIMD156392084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology