Provider Demographics
NPI:1174657795
Name:CARLOW, WARREN ALFRED JR
Entity type:Individual
Prefix:MR
First Name:WARREN
Middle Name:ALFRED
Last Name:CARLOW
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 PONTIAC AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-4406
Mailing Address - Country:US
Mailing Address - Phone:401-738-6450
Mailing Address - Fax:401-732-5369
Practice Address - Street 1:1580 PONTIAC AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-4406
Practice Address - Country:US
Practice Address - Phone:401-738-6450
Practice Address - Fax:401-732-5369
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICO00007222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Not Answered224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9009703Medicaid
MA1528157Medicaid
RI9703OtherBLUE CROSS OF RI
RI0125110001Medicare ID - Type UnspecifiedMEDICARE