Provider Demographics
NPI:1568457323
Name:BRECHER, KEITH R (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:R
Last Name:BRECHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 CENTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4394
Mailing Address - Country:US
Mailing Address - Phone:401-732-3332
Mailing Address - Fax:401-739-0196
Practice Address - Street 1:227 CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4394
Practice Address - Country:US
Practice Address - Phone:401-732-3332
Practice Address - Fax:401-739-0196
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD11608174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI050513332OtherCHAMPAS
RI9143373OtherPHCS
RIAA19864OtherPILGRIM
RI3740870OtherAETNA
RI494200OtherTUFTS
RI050513332OtherHUMANA
RI29119OtherBLUE CROSS BLUE SHIELD
RI050513332OtherUNITED HEALTHCARE
RI411996OtherBLUE CHIP
RI9003890Medicaid
RI1568457323OtherNPI
RI3740870OtherAETNA