Healthcare Provider Details

I. General information

NPI: 1861592156
Provider Name (Legal Business Name): ALEXIOS GEORGE CARAYANNOPOULOS D.O., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 11/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

117 ELLENFIELD STREET SUITE 101
PROVIDENCE RI
02905-4513
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-3777
  • Fax: 401-444-7249
Mailing address:
  • Phone: 401-444-4318
  • Fax: 401-444-6912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberDO00763
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: