Healthcare Provider Details

I. General information

NPI: 1467586008
Provider Name (Legal Business Name): MR. MATTHEW WARREN CARLOW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 PONTIAC AVE
CRANSTON RI
02920-4406
US

IV. Provider business mailing address

1580 PONTIAC AVE
CRANSTON RI
02920-4406
US

V. Phone/Fax

Practice location:
  • Phone: 401-738-6450
  • Fax: 401-732-5369
Mailing address:
  • Phone: 401-738-6450
  • Fax: 401-732-5369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCO00008
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCP00012
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberCO00008
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: