Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | MD11407 | RI |
NPI | 1003871856 |
---|---|
Provider Name | Thomas Fairweather Crain |
First Address | Providence, RI 02906-2853 |
Second Address | Providence, RI 02906-2853 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 20/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B36780 | (02) |