Basic Information
| Provider Information | |||||||||
| NPI: | 1902983976 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARRETT | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | THERESE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 117 ELLENFIELD ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029054541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014446779 | ||||||||
| FaxNumber: | 4014446912 | ||||||||
| Practice Location | |||||||||
| Address1: | 19 FRIENDSHIP ST UNIT 220 | ||||||||
| Address2: | |||||||||
| City: | NEWPORT | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028402264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4018485556 | ||||||||
| FaxNumber: | 4018454379 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 11/07/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MD16855 | RI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 174400000X | 29546 | CO | N | Other Service Providers | Specialist | 207V00000X | 01074809B | IN | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.