Healthcare Provider Details

I. General information

NPI: 1306914130
Provider Name (Legal Business Name): JAMES E CARNEY PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEMORIAL HOSPITAL OF RHODE ISLAND 111 BREWSTER STREET
PAWTUCKET RI
02860
US

IV. Provider business mailing address

111 BREWSTER STREET
PAWTUCKET RI
02860
US

V. Phone/Fax

Practice location:
  • Phone: 401-729-2000
  • Fax: 401-729-3866
Mailing address:
  • Phone: 401-729-2000
  • Fax: 401-729-3866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA00009
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: