Provider Demographics
NPI:1851848949
Name:BROOKSIDE MEDICAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:BROOKSIDE MEDICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:
Authorized Official - Last Name:DOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-658-1197
Mailing Address - Street 1:106 NATE WHIPPLE HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-1428
Mailing Address - Country:US
Mailing Address - Phone:401-658-2020
Mailing Address - Fax:
Practice Address - Street 1:106 NATE WHIPPLE HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-1428
Practice Address - Country:US
Practice Address - Phone:401-658-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty