MEDICARE: DR. JOHNNY CHAVARRIA M.D.

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	208000000X	Pediatrics Physician	8929	RI
2	208000000X	Pediatrics Physician	MD08929	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	204693	OTHER	RI	BCBS
2	AA41503	OTHER		HARVARD PILGRIM INS
3	8929	OTHER	RI	STATE LICENSE
4	204491	OTHER	RI	CHCP BLUE CHIP
5	582062	OTHER		AETNA INS
6	1201179	OTHER		UNITED HEALTH PLAN
7	3859	OTHER	RI	NEIGHBORHOOD HEALTH PLAN
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316923352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHNNY CHAVARRIA M.D.

Provider Business Mailing Address
First Line	:	161 AIRPORT RD
Second Line	:
City	:	WARWICK
State	:	RI
Zip	:	02889-1031
Country	:	US
Telephone Number	:	401-737-4282
Fax Number	:	401-738-6896

Provider Business Practice Location Address
First Line	:	161 AIRPORT RD
Second Line	:
City	:	WARWICK
State	:	RI
Zip	:	02889-1031
Country	:	US
Telephone Number	:	401-737-4282
Fax Number	:	401-738-6896

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

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	04/29/2014

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Directions to “ DR. JOHNNY CHAVARRIA M.D.” Practice Location

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