Provider Demographics
NPI:1619079852
Name:ROBERT A. CARRELLAS, M.D, P.C.
Entity Type:Organization
Organization Name:ROBERT A. CARRELLAS, M.D, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARRELLAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-847-9955
Mailing Address - Street 1:674 AQUIDNECK AVE
Mailing Address - Street 2:BUILDING A, UNIT 1
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-5692
Mailing Address - Country:US
Mailing Address - Phone:401-847-9955
Mailing Address - Fax:401-847-9948
Practice Address - Street 1:674 AQUIDNECK AVE
Practice Address - Street 2:BUILDING A, UNIT 1
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-5692
Practice Address - Country:US
Practice Address - Phone:401-847-9955
Practice Address - Fax:401-847-9948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI8200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7002857Medicaid
RI007010422Medicare PIN
RI7002857Medicaid