Provider Demographics
NPI:1497716054
Name:THRAN, ALEXANDRA NICOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:NICOLE
Last Name:THRAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:A. NICOLE
Other - Middle Name:
Other - Last Name:BRUNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:561 SEASIDE DR
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02835-2357
Mailing Address - Country:US
Mailing Address - Phone:401-527-8224
Mailing Address - Fax:
Practice Address - Street 1:561 SEASIDE DR
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:RI
Practice Address - Zip Code:02835-2357
Practice Address - Country:US
Practice Address - Phone:401-527-8224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD10960207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7010378Medicaid
RI7010378Medicaid
RIF95966Medicare UPIN