Provider Demographics
NPI:1407835614
Name:BROWN, GAIL R (MD)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:R
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10 DAVOL SQ
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4754
Mailing Address - Country:US
Mailing Address - Phone:401-421-4000
Mailing Address - Fax:401-272-1456
Practice Address - Street 1:315 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2778
Practice Address - Country:US
Practice Address - Phone:401-732-5437
Practice Address - Fax:401-615-7529
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301071395208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4303689Medicaid
MI3503905411OtherBLUE CROSS PIN
MI4301071395OtherPHYSICIAN LICENSE
MIP110973OtherBLUE CHOICE
MIP110973OtherBLUE CHOICE