Basic Information
| Provider Information | |||||||||
| NPI: | 1629464748 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HACKETT | ||||||||
| FirstName: | CHARLES | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 455 TOLL GATE RD | ||||||||
| Address2: | |||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028862759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017377000 | ||||||||
| FaxNumber: | 4017364546 | ||||||||
| Practice Location | |||||||||
| Address1: | 1405 S COUNTY TRL STE 510 | ||||||||
| Address2: | |||||||||
| City: | EAST GREENWICH | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028185097 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017364570 | ||||||||
| FaxNumber: | 4019216931 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2015 | ||||||||
| LastUpdateDate: | 05/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 60758 | MN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD16268 | RI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.