Provider Demographics
NPI:1649206236
Name:BRINDLE, ALLISON WENTWORTH (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:WENTWORTH
Last Name:BRINDLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:WENTWORTH
Other - Last Name:BRINDLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:593 EDDY ST
Mailing Address - Street 2:HASBRO 122
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4923
Mailing Address - Country:US
Mailing Address - Phone:401-444-5980
Mailing Address - Fax:401-444-3873
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-444-5980
Practice Address - Fax:401-444-3873
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD14498208000000X
OH35088555208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIMD14498OtherLICENSE
I09778Medicare UPIN