Provider Demographics
NPI:1952539132
Name:BRANNIGAN, CHRISTOPHER T (PA)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:T
Last Name:BRANNIGAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 ELM ST FL 3
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4626
Mailing Address - Country:US
Mailing Address - Phone:401-443-4992
Mailing Address - Fax:401-537-7241
Practice Address - Street 1:375 WAMPANOAG TRL STE 401
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-2237
Practice Address - Country:US
Practice Address - Phone:401-632-4455
Practice Address - Fax:443-432-6997
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA6129363A00000X
RIPA01322363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD145724700OtherDEPT OF LABOR
6296523OtherAETNA HMO
9115490OtherAETNA PPO
9115490OtherAETNA PPO
MD145724700OtherDEPT OF LABOR
P00889991Medicare PIN
159076ZADNMedicare PIN