Basic Information
Provider Information
NPI: 1003012014
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCARFO
FirstName: KEITH-AUSTIN
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 117 ELLENFIELD ST
Address2: SUITE 101
City: PROVIDENCE
State: RI
PostalCode: 029054513
CountryCode: US
TelephoneNumber: 4014446779
FaxNumber: 4014446912
Practice Location
Address1: 593 EDDY ST
Address2: APC 6
City: PROVIDENCE
State: RI
PostalCode: 029034923
CountryCode: US
TelephoneNumber: 4014443777
FaxNumber: 4014447249
Other Information
ProviderEnumerationDate: 06/26/2007
LastUpdateDate: 06/09/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000XDO00785RIY Allopathic & Osteopathic PhysiciansAnesthesiology 
207L00000X247764MAN Allopathic & Osteopathic PhysiciansAnesthesiology 
207LP2900XRT-2103NHN Allopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine

No ID Information.


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