Provider Demographics
NPI:1093983496
Name:PETER C. BRASCH, MD, LLC
Entity Type:Organization
Organization Name:PETER C. BRASCH, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRASCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-487-3963
Mailing Address - Street 1:1 THURBER BLVD
Mailing Address - Street 2:
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:
Practice Address - Street 1:1 THURBER BLVD
Practice Address - Street 2:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PETER C. BRASCH, MD, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-19
Last Update Date:2008-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI6132950001Medicare NSC