Provider Demographics
NPI:1902850415
Name:BREM, ANDREW S (MD)
Entity Type:Individual
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First Name:ANDREW
Middle Name:S
Last Name:BREM
Suffix:
Gender:M
Credentials:MD
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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:401-444-6484
Mailing Address - Fax:401-444-6378
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:APC 6
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-444-5672
Practice Address - Fax:401-444-3944
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2008-01-30
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Provider Licenses
StateLicense IDTaxonomies
RI055052080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9006005Medicaid
RIC90805Medicare UPIN