| Name: | Brown Dermatology, Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Non-Profit Corporation |
| Status: | Activ |
| Date of Organization in Rhode Island: | 08 Jun 2016 (9 years ago) |
| Identification Number: | 001663984 |
| ZIP code: | 02903 |
| County: | Providence County |
| Principal Address: | 593 EDDY STREET-APC10, PROVIDENCE, RI, 02903, USA |
| Purpose: | TO PROMOTE HEALTH BY PROVIDING CLINICAL AND MEDICAL CARE TO PATIENTS AS THE FACULTY GROUP PRACTICE ORGANIZATION FOR THE DEPARTMENT OF DERMATOLOGY AT THE WARREN ALPERT MEDICAL SCHOOL AT BROWN UNIVERSITY (ALPERT MEDICAL SCHOOL); TO OPERATE THE CLINICAL AND PATIENT CARE SERVICES OF THE FACULTY GROUP PRACTICE ORGANIZATION FOR THE BENEFIT AND SUPPORT OF THE TEACHING, RESEARCH, CLINICAL, AND PATIENT CARE MISSIONS OF THE DEPARTMENT OF DERMATOLOGY AT THE ALPERT MEDICAL SCHOOL AND HOSPITALS WITHIN THE STATE OF RHODE ISLAND THAT ARE AFFILIATED WITH THE ALPERT MEDICAL SCHOOL; TO ENGAGE IN RESEARCH, EDUCATION OF MEDICAL STUDENTS AT THE ALPERT MEDICAL SCHOOL, AND EDUCATION OF MEDICAL SCHOOL GRADUATES IN POSTGRADUATE TRAINING PROGRAMS AT HOSPITALS WITHIN THE STATE OF RHODE ISLAND THAT ARE AFFILIATED WITH THE ALPERT MEDICAL SCHOOL; AND TO PROVIDE ADMINISTRATIVE SERVICES TO THE DEPARTMENT OF DERMATOLOGY AT THE ALPERT MEDICAL SCHOOL AND TO DERMATOLOGY DEPARTMENTS AT HOSPITALS WITHIN THE STATE OF RHODE ISLAND THAT ARE AFFILIATED WITH THE ALPERT MEDICAL SCHOOL. |
| NAICS: | 622310 - Specialty (except Psychiatric and Substance Abuse) Hospitals |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1730538026 | 2016-06-07 | 2018-06-29 | 593 EDDY ST, APC-10, PROVIDENCE, RI, 029034923, US | 593 EDDY ST, APC-10, PROVIDENCE, RI, 029034923, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 401-444-7959 |
| Fax | 4014447105 |
| Fax | 4014447144 |
Authorized person
| Name | DR. ABRAR QURESHI |
| Role | CHAIR |
| Phone | 4014447137 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| Is Primary | Yes |
| Taxonomy Code | 207ND0101X - MOHS-Micrographic Surgery Physician |
| Is Primary | No |
| Taxonomy Code | 207ND0900X - Dermatopathology Physician |
| Is Primary | No |
| Taxonomy Code | 207NP0225X - Pediatric Dermatology Physician |
| Is Primary | No |
| Taxonomy Code | 207NS0135X - Procedural Dermatology Physician |
| Is Primary | No |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BROWN DERMATOLOGY INC. 401(K) PROFIT SHARING PLAN AND TRUST | 2019 | 061475105 | 2020-08-07 | BROWN DERMATOLOGY INC. | 120 | |||||||||||||||||||||||
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| BROWN DERMATOLOGY INC 401 K PROFIT SHARING PLAN TRUST | 2016 | 812847155 | 2017-06-26 | BROWN DERMATOLOGY INC | 84 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2017-06-26 |
| Name of individual signing | ABRAR QURESHI |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| MICHAEL A. GAMBOLL, ESQ. | Agent | PARTRIDGE SNOW & HAHN LLP 40 WESTMINSTER ST SUITE 1100, PROVIDENCE, RI, 02903, USA |
| Name | Role | Address |
|---|---|---|
| ABRAR A QURESHI MD,MPH | PRESIDENT | 24 HALLETT HILL ROAD WESTON, MA 02493 USA |
| Name | Role | Address |
|---|---|---|
| ABRAR A QURESHI MD MPH | TREASURER | 24 HALLETT HILL ROAD WESTON, MA 02493 USA |
| Name | Role | Address |
|---|---|---|
| NICOLE GRENIER MD | SECRETARY | 451 GILBERT STUART ROAD SAUNDERSTOWN, RI 02874 USA |
| Name | Role | Address |
|---|---|---|
| SU-JEAN SEO MD | VICE PRESIDENT | 21 BARNES STREET PROVIDENCE, RI 02906 USA |
| Name | Role | Address |
|---|---|---|
| MUKESH JAIN MD | DIRECTOR | 580 SOUTH WATER ST. APT 509 PROVIDENCE, RI 02903 USA |
| JON SOLIS MD | DIRECTOR | 1 STARVIEW LANE WESTERLY, RI 02891 USA |
| KIMBERLY A GALLIGAN MBA | DIRECTOR | 50 SPENCER AVENUE EAST GREENWICH, RI 02818 USA |
| SU-JEAN SEO MD | DIRECTOR | 21 BARNES STREET PROVIDENCE, RI 02906 USA |
| LESLIE ROBINSON-BOSTOM | DIRECTOR | 130 GOLDMINE RD GLOCESTER, RI 02814 USA |
| Number | Name | File Date |
|---|---|---|
| 202447900440 | Annual Report | 2024-03-06 |
| 202327571890 | Annual Report | 2023-02-06 |
| 202213377120 | Annual Report | 2022-03-24 |
| 202197845730 | Annual Report | 2021-06-07 |
| 202041279410 | Annual Report | 2020-06-02 |
| 201995169590 | Annual Report | 2019-05-31 |
| 201872824570 | Annual Report | 2018-07-25 |
| 201872338680 | Statement of Change of Registered/Resident Agent | 2018-07-12 |
| 201746798110 | Annual Report | 2017-06-30 |
| 201600343120 | Articles of Incorporation | 2016-06-08 |
Date of last update: 26 Oct 2024
Sources: Rhode Island Department of State
