MEDICARE: DR. SARA ELIZABETH CHARNECKI MD

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	207Q00000X	Family Medicine Physician	MD16814	RI

General Provider Information

NPI Number	:	1104879766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARA ELIZABETH CHARNECKI MD

Provider Business Mailing Address
First Line	:	200 MILL RD STE 180
Second Line	:
City	:	FAIRHAVEN
State	:	MA
Zip	:	02719-5255
Country	:	US
Telephone Number	:	508-973-2000
Fax Number	:	508-973-2001

Provider Business Practice Location Address
First Line	:	1800 MAIN RD
Second Line	:
City	:	TIVERTON
State	:	RI
Zip	:	02878-4625
Country	:	US
Telephone Number	:	401-625-5552
Fax Number	:	401-625-5277

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	04/21/2020

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