Provider Demographics
NPI:1124079090
Name:CRISAFI, BARTEL ROBERT JR (MD)
Entity type:Individual
Prefix:
First Name:BARTEL
Middle Name:ROBERT
Last Name:CRISAFI
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-3177
Mailing Address - Country:US
Mailing Address - Phone:401-596-6464
Mailing Address - Fax:401-348-8660
Practice Address - Street 1:77 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-3177
Practice Address - Country:US
Practice Address - Phone:401-596-6464
Practice Address - Fax:401-348-8660
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI10663207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIP0050145OtherRAILROAD MEDICARE
RI9023434Medicaid
RIP0050145OtherRAILROAD MEDICARE
G25568Medicare UPIN
RI9023434Medicaid