# BROADWAY MEDICAL TREATMENT CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104010032
- **Authorized official:** DR. PETER GEORGE BRASSARD M.D. (PHYSICIAN / OWNER)
- **Authorized official phone:** (401) 438-5551

## Contact information

- **Practice address:** 1053 S BROADWAY, EAST PROVIDENCE, RI 02914-4729
- **Practice address phone:** (401) 438-5551
- **Practice address fax:** (401) 438-7272
- **Mailing address:** 1053 S BROADWAY, EAST PROVIDENCE, RI 02914-4729
- **Mailing address phone:** (401) 438-5551
- **Mailing address fax:** (401) 438-7272

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | CMD 06972 | RI | Yes |

## Other

- **Enumeration date:** 09/04/2007
- **Last updated:** 09/04/2007