Name: | Robert A. Carrellas. M.D., Inc. |
Jurisdiction: | Rhode Island |
Entity type: | Domestic Profit Corporation |
Status: | Activ |
Date of Organization in Rhode Island: | 02 Jun 2003 (22 years ago) |
Identification Number: | 000132416 |
ZIP code: | 02842 |
County: | Newport County |
Principal Address: | 674 AQUIDNECK AVENUE, MIDDLETOWN, RI, 02842, USA |
Purpose: | MEDICAL PRACTICE |
NAICS: | 621491 - HMO Medical Centers |
NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1619079852 | 2006-09-01 | 2009-08-20 | 674 AQUIDNECK AVE, BUILDING A, UNIT 1, MIDDLETOWN, RI, 028425692, US | 674 AQUIDNECK AVE, BUILDING A, UNIT 1, MIDDLETOWN, RI, 028425692, US | |||||||||||||||||||||||||
|
Phone | +1 401-847-9955 |
Fax | 4018479948 |
Authorized person
Name | DR. ROBERT A CARRELLAS |
Role | PRESIDENT |
Phone | 4018479955 |
Taxonomy
Taxonomy Code | 207Q00000X - Family Medicine Physician |
License Number | 8200 |
State | RI |
Is Primary | Yes |
Other Provider Identifiers
Issuer | MEDICAID |
Number | 7002857 |
State | RI |
Name | Role | Address |
---|---|---|
NEIL P. GALVIN | Agent | 10A WASHINGTON SQUARE, NEWPORT, RI, 02840, USA |
Name | Role | Address |
---|---|---|
ROBERT ANTHONY CARRELLAS | PRESIDENT | 127 RIVERVIEW AVENUE MIDDLETOWN, RI 02842 UNI |
ROBERT A CARRELLAS MD | PRESIDENT | 674 AQUIDNECK AVENUE MIDDLETOWN, RI 02842 USA |
Name | Role | Address |
---|---|---|
ROBERT ANTHONY CARRELLAS MD | OTHER OFFICER | 127 RIVERVIEW AVE MIDDLETOWN, RI 02842 UNI |
Number | Name | File Date |
---|---|---|
202458622870 | Annual Report | 2024-08-07 |
202457158460 | Revocation Notice For Failure to File An Annual Report | 2024-06-25 |
202334355670 | Annual Report | 2023-04-27 |
202213515270 | Annual Report | 2022-03-27 |
202198744780 | Annual Report | 2021-06-28 |
202196817710 | Revocation Notice For Failure to File An Annual Report | 2021-05-19 |
202044204770 | Annual Report | 2020-07-05 |
201989683680 | Annual Report | 2019-04-01 |
201864549140 | Statement of Change of Registered/Resident Agent Office | 2018-05-10 |
201859756500 | Annual Report | 2018-03-05 |
Date of last update: 09 Oct 2024
Sources: Rhode Island Department of State