Provider Demographics
NPI:1407840903
Name:BREX, CHARLES JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JOHN
Last Name:BREX
Suffix:
Gender:M
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 1:450 VETERANS MEMORIAL PKWY
Practice Address - Street 2:BLDG 4
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-5300
Practice Address - Country:US
Practice Address - Phone:401-435-3400
Practice Address - Fax:401-435-3586
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2011-03-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
RIMD05092207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI2028069OtherHEALTH CARE VALUE MGT
RI003528OtherBLUE CHIP
RI709004046OtherMEDICARE GROUP
RI050483739OtherGREAT-WEST HEALTH CARE
RI7003045Medicaid
RI04-00513OtherUNITED HEALTH CARE
RI2477-0OtherBCBS OF RI
RI007057448OtherMEDICARE
RI12010315OtherMULTIPLAN
RI404463OtherTUFTS HEALTH PLAN
RI60785OtherHARVARD HEALTH PLAN
RI110195915OtherRAILROAD MEDICARE
RI710041001OtherCIGNA
RI60785OtherHARVARD HEALTH PLAN
RI60785OtherHARVARD HEALTH PLAN