Individual
BRIAN CLYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
593 EDDY ST, CLAVERICK 2, PROVIDENCE, RI 02903-4923
(401) 854-2504
(401) 854-2519
Mailing address
PO BOX 9484, PROVIDENCE, RI 02940-9484
(401) 854-2508
(401) 854-2519
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD10332
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0107964
—
MA
01
—
1083638928
NPI
RI
01
—
12/14/2006
NHPRI
RI
01
—
12/29/2008
TUFTS
RI
05
—
7008267
—
RI
01
—
930093283
RAILROAD MEDICARE
RI
01
—
939025129
RI MEDICARE GROUP NUMBER
RI
Enumeration date
07/26/2006
Last updated
09/17/2013
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