Individual
C BRANDON QUALLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
345 BLACKSTONE BLVD, WELD BLDG, PROVIDENCE, RI 02906
(401) 421-0060
(401) 421-6616
Mailing address
345 BLACKSTONE BLVD, WELD BLDG, PROVIDENCE, RI 02906
(401) 421-0060
(401) 421-6616
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD04942
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9001265
—
RI
Enumeration date
11/03/2006
Last updated
06/26/2018
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