Provider Demographics
NPI:1558539957
Name:HACKETT, CHARLES D (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:D
Last Name:HACKETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:593 EDDY STREET
Mailing Address - Street 2:GRADS DORM
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4923
Mailing Address - Country:US
Mailing Address - Phone:401-444-4038
Mailing Address - Fax:401-444-7074
Practice Address - Street 1:593 EDDY STREET
Practice Address - Street 2:GRADS DORM
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-444-4038
Practice Address - Fax:401-444-7074
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2018-02-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
RIMD152942083X0100X
MA206089207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine