Organization
LIFESPAN PHYSICIAN GROUP INC
Active
Parent organization
LIFESPAN CORPORATION
Other names
Brown Health Medical Group
Organization subpart
Yes
Provider details
NPI number
Legal business name
LIFESPAN CORPORATION
Authorized official
MR. PETER K MARKELL (EVP & CFO)
(401) 444-7914
Entity
Organization
Contact information
Practice address
593 EDDY STREET, PROVIDENCE, RI 02903
(401) 444-7442
Mailing address
117 ELLENFIELD ST STE 101, PROVIDENCE, RI 02905-4541
(401) 444-6779
(401) 444-6912
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
—
—
103T00000X
Psychologist
—
—
103TC0700X
Clinical Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
2084B0040X
Behavioral Neurology & Neuropsychiatry Physician
—
—
2084N0400X
Neurology Physician
—
—
2084N0600X
Clinical Neurophysiology Physician
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
12/17/2012
Last updated
04/03/2026
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