MEDICARE: CRITICAL CARE ASSOCIATES, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LC0200X	Critical Care Medicine (Anesthesiology) Physician

General Provider Information

NPI Number	:	1134694714
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRITICAL CARE ASSOCIATES, PC

Provider Business Mailing Address
First Line	:	15 MILLERS BROOK DR
Second Line	:
City	:	CUMBERLAND
State	:	RI
Zip	:	02864-6158
Country	:	US
Telephone Number	:	401-692-5292
Fax Number	:	781-326-5950

Provider Business Practice Location Address
First Line	:	15 LITTLE BOOT LN
Second Line	:
City	:	WESTWOOD
State	:	MA
Zip	:	02090-2648
Country	:	US
Telephone Number	:	401-692-5292
Fax Number	:	781-326-5950

Authorized Official
Title or Position	:	OWNER
Name	:	KHALED SOROUR
Credential	:	MD
Telephone Number	:	401-692-5292

Provider Enumeration Date	:	10/10/2018
Last Update Date	:	10/10/2018

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