1578694188 NPI number — CRANSTON ARC

Table of content: DR. BRIAN GARY CHARLESWORTH PHD (NPI 1447303169)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578694188 NPI number — CRANSTON ARC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRANSTON ARC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578694188
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 COMSTOCK PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRANSTON
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02921-2002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-941-1112
Provider Business Mailing Address Fax Number:
401-941-2516

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
247 POPLAR DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRANSTON
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02920-5550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-941-1112
Provider Business Practice Location Address Fax Number:
401-941-2516
Provider Enumeration Date:
03/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COPPAGE
Authorized Official First Name:
PAT
Authorized Official Middle Name:
Authorized Official Title or Position:
FINANCIAL DIRECTOR
Authorized Official Telephone Number:
401-941-1112

Provider Taxonomy Codes

  • Taxonomy code: 320600000X , with the licence number:  30 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AC02747 . This is a "EDS PROVIDER NUMBER" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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