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Robert A. Carrellas. M.D., Inc.

Company Details

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

National Provider Identifier

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

Contacts

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

Agent

Name Role Address
NEIL P. GALVIN Agent 10A WASHINGTON SQUARE, NEWPORT, RI, 02840, USA

PRESIDENT

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

OTHER OFFICER

Name Role Address
ROBERT ANTHONY CARRELLAS MD OTHER OFFICER 127 RIVERVIEW AVE MIDDLETOWN, RI 02842 UNI

Filings

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