Provider Demographics
NPI:1467586008
Name:CARLOW, MATTHEW WARREN
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:WARREN
Last Name:CARLOW
Suffix:
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
RICO00008222Z00000X, 225000000X
RICP00012224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Not Answered224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Not Answered225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI200260OtherBLUECHIP
RI9703OtherBCBS OF RI
RI9009703Medicaid
RI0125110001Medicare ID - Type UnspecifiedMEDICARE