Organization · NPI-2

Lifespan Physician Group, INC.

General Practice · Providence, RI

NPI number1407116643

StatusActive

Last updated in NPPESOct 7, 2025

Details

NPI: 1407116643
Entity type: Organization (NPI-2)
Legal business name: Lifespan Physician Group, INC.
Organization subpart: Yes
Enumeration date: May 22, 2012
Certification date: Oct 7, 2025
Last updated: Oct 7, 2025

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
208D00000X	General Practice	–	–	Yes
208600000X	Surgery	–	–
2086S0102X	Surgery, Surgical Critical Care	–	–
133V00000X	Dietitian, Registered	–	–
208C00000X	Colon & Rectal Surgery	–	–
2086S0129X		–	–
152W00000X	Optometrist	–	–
2086S0127X	Surgery, Trauma Surgery	–	–
207V00000X	Obstetrics & Gynecology	–	–
204F00000X	Transplant Surgery	–	–
208200000X	Plastic Surgery	–	–
2086X0206X	Surgery, Surgical Oncology	–	–
208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery)	–	–
2086S0120X	Surgery, Pediatric Surgery	–	–
207LC0200X	Anesthesiology, Critical Care Medicine	–	–

Other names

Brown Health Medical Group (Doing Business As)

Practice location

593 Eddy St
Providence, RI 02903-4923

Phone 401-444-6779 · Fax 401-444-6912

Mailing address

117 Ellenfield St
Suite 101
Providence, RI 02905-4513

Phone 401-444-6779 · Fax 401-444-6912

Authorized official

Peter K Markell
Evp & Cfo
4014447914

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