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  5. David A. Carcieri, M.D., Inc.

David A. Carcieri, M.D., Inc.

Company Details

Name: David A. Carcieri, M.D., Inc.
Jurisdiction: Rhode Island
Entity type: Domestic Profit Corporation
Status: Activ
Date of Organization in Rhode Island: 06 Apr 2005 (20 years ago)
Identification Number: 000147151
ZIP code: 02904
County: Providence County
Principal Address: 1637 MINERAL SPRING AVENUE SUITE 211, NORTH PROVIDENCE, RI, 02904, USA
Purpose: TO ENGAGE IN THE PRACTICE OF MEDICINE
NAICS: 621111 - Offices of Physicians (except Mental Health Specialists)

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1558462234 2006-09-26 2020-08-22 1637 MINERAL SPRING AVE, SUITE 117, NORTH PROVIDENCE, RI, 029044042, US 1637 MINERAL SPRING AVE, SUITE 117, NORTH PROVIDENCE, RI, 029044042, US

Contacts
Phone +1 401-353-0757

Authorized person
Name DR. DAVID A CARCIERI
Role PRESIDENT
Phone 4013530757

Taxonomy
Taxonomy Code 207V00000X - Obstetrics & Gynecology Physician
License Number MD8594
State RI
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number DC57874
State RI

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
DAVID A. CARCIERI, M.D., INC. 401(K) PROFIT SHARING PLAN 2023 202628512 2024-05-06 DAVID A. CARCIERI, M.D., INC. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-04-06
Business code 621111
Sponsor’s telephone number 4013530757
Plan sponsor’s address 1637 MINERAL SPRING AVENUE, NORTH PROVIDENCE, RI, 02904
DAVID A. CARCIERI, M.D., INC. 401(K) PROFIT SHARING PLAN 2022 202628512 2023-03-09 DAVID A. CARCIERI, M.D., INC. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-04-06
Business code 621111
Sponsor’s telephone number 4013530757
Plan sponsor’s address 1637 MINERAL SPRING AVENUE, NORTH PROVIDENCE, RI, 02904
DAVID A. CARCIERI, M.D., INC. 401(K) PROFIT SHARING PLAN 2021 202628512 2022-02-28 DAVID A. CARCIERI, M.D., INC. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-04-06
Business code 621111
Sponsor’s telephone number 4013530757
Plan sponsor’s address 1637 MINERAL SPRING AVENUE, NORTH PROVIDENCE, RI, 02904
DAVID A. CARCIERI, M.D., INC. 401(K) PROFIT SHARING PLAN 2020 202628512 2021-03-30 DAVID A. CARCIERI, M.D., INC. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-04-06
Business code 621111
Sponsor’s telephone number 4013530757
Plan sponsor’s address 1637 MINERAL SPRING AVENUE, NORTH PROVIDENCE, RI, 02904
DAVID A. CARCIERI, M.D., INC. 401(K) PROFIT SHARING PLAN 2020 202628512 2021-03-30 DAVID A. CARCIERI, M.D., INC. 3
Three-digit plan number (PN) 001
Effective date of plan 2005-04-06
Business code 621111
Sponsor’s telephone number 4013530757
Plan sponsor’s address 1637 MINERAL SPRING AVENUE, NORTH PROVIDENCE, RI, 02904
DAVID A. CARCIERI, M.D., INC. 401(K) PROFIT SHARING PLAN 2019 202628512 2020-03-30 DAVID A. CARCIERI, M.D., INC. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-04-06
Business code 621111
Sponsor’s telephone number 4013530757
Plan sponsor’s address 1637 MINERAL SPRING AVENUE, NORTH PROVIDENCE, RI, 02904
DAVID A. CARCIERI, M.D., INC. 401(K) PROFIT SHARING PLAN 2018 202628512 2019-03-13 DAVID A. CARCIERI, M.D., INC. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-04-06
Business code 621111
Sponsor’s telephone number 4013530757
Plan sponsor’s address 1637 MINERAL SPRING AVENUE, NORTH PROVIDENCE, RI, 02904
DAVID A. CARCIERI, M.D., INC. 401(K) PROFIT SHARING PLAN 2017 202628512 2018-03-19 DAVID A. CARCIERI, M.D., INC. 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-04-06
Business code 621111
Sponsor’s telephone number 4013530757
Plan sponsor’s address 1637 MINERAL SPRING AVENUE, NORTH PROVIDENCE, RI, 02904
DAVID A. CARCIERI, M.D., INC. 401(K) PROFIT SHARING PLAN 2016 202628512 2017-06-09 DAVID A. CARCIERI, M.D., INC. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-04-06
Business code 621111
Sponsor’s telephone number 4013530757
Plan sponsor’s address 1637 MINERAL SPRING AVENUE, NORTH PROVIDENCE, RI, 02904
DAVID A. CARCIERI, M.D., INC. 401(K) PROFIT SHARING PLAN 2015 202628512 2016-04-11 DAVID A. CARCIERI, M.D., INC. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-04-06
Business code 621111
Sponsor’s telephone number 4013530757
Plan sponsor’s address 1637 MINERAL SPRING AVENUE, NORTH PROVIDENCE, RI, 02904

Plan administrator’s name and address
Administrator’s EIN 202628512
Plan administrator’s name DAVID A. CARCIERI, M.D., INC.
Plan administrator’s address 1637 MINERAL SPRING AVENUE, NORTH PROVIDENCE, RI, 02904
Administrator’s telephone number 4013530757
File https://efast2-filings-public.s3.amazonaws.com/prd/2015/06/02/20150602085117P040030777345001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2005-04-06
Business code 621111
Sponsor’s telephone number 4013530757
Plan sponsor’s address 1637 MINERAL SPRING AVENUE, NORTH PROVIDENCE, RI, 02904

Plan administrator’s name and address
Administrator’s EIN 202628512
Plan administrator’s name DAVID A. CARCIERI, M.D., INC.
Plan administrator’s address 1637 MINERAL SPRING AVENUE, NORTH PROVIDENCE, RI, 02904
Administrator’s telephone number 4013530757

Signature of
Role Plan administrator
Date 2015-06-02
Name of individual signing DAVID A. CARCIERI, M.D.
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/05/19/20140519090208P030115628261001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2005-04-06
Business code 621111
Sponsor’s telephone number 4013530757
Plan sponsor’s address 1637 MINERAL SPRING AVENUE, NORTH PROVIDENCE, RI, 02904

Plan administrator’s name and address
Administrator’s EIN 202628512
Plan administrator’s name DAVID A. CARCIERI, M.D., INC.
Plan administrator’s address 1637 MINERAL SPRING AVENUE, NORTH PROVIDENCE, RI, 02904
Administrator’s telephone number 4013530757

Signature of
Role Plan administrator
Date 2014-05-19
Name of individual signing DAVID A. CARCIERI, M.D.
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/06/12/20130612170007P040012333794001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2005-04-06
Business code 621111
Sponsor’s telephone number 4013530757
Plan sponsor’s address 1637 MINERAL SPRING AVENUE, NORTH PROVIDENCE, RI, 02904

Plan administrator’s name and address
Administrator’s EIN 202628512
Plan administrator’s name DAVID A. CARCIERI, M.D., INC.
Plan administrator’s address 1637 MINERAL SPRING AVENUE, NORTH PROVIDENCE, RI, 02904
Administrator’s telephone number 4013530757

Signature of
Role Plan administrator
Date 2013-06-12
Name of individual signing DAVID A. CARCIERI, M.D.
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/05/02/20120502131131P040005433682001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2005-04-06
Business code 621111
Sponsor’s telephone number 4013530757
Plan sponsor’s address 1637 MINERAL SPRING AVENUE, NORTH PROVIDENCE, RI, 02904

Plan administrator’s name and address
Administrator’s EIN 202628512
Plan administrator’s name DAVID A. CARCIERI, M.D., INC.
Plan administrator’s address 1637 MINERAL SPRING AVENUE, NORTH PROVIDENCE, RI, 02904
Administrator’s telephone number 4013530757

Signature of
Role Plan administrator
Date 2012-05-02
Name of individual signing DAVID A. CARCIERI, M.D.
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/10/04/20111004113548P040145712161001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2005-04-06
Business code 621111
Sponsor’s telephone number 4013530757
Plan sponsor’s address 1637 MINERAL SPRING AVENUE, NORTH PROVIDENCE, RI, 02904

Plan administrator’s name and address
Administrator’s EIN 202628512
Plan administrator’s name DAVID A. CARCIERI, M.D., INC.
Plan administrator’s address 1637 MINERAL SPRING AVENUE, NORTH PROVIDENCE, RI, 02904
Administrator’s telephone number 4013530757

Signature of
Role Plan administrator
Date 2011-10-04
Name of individual signing DAVID A. CARCIERI, M.D.
Valid signature Filed with authorized/valid electronic signature
Three-digit plan number (PN) 001
Effective date of plan 2005-04-06
Business code 621111
Sponsor’s telephone number 4013530757
Plan sponsor’s address 1637 MINERAL SPRING AVENUE, NORTH PROVIDENCE, RI, 02904

Plan administrator’s name and address
Administrator’s EIN 202628512
Plan administrator’s name DAVID A. CARCIERI, M.D., INC.
Plan administrator’s address 1637 MINERAL SPRING AVENUE, NORTH PROVIDENCE, RI, 02904
Administrator’s telephone number 4013530757

Signature of
Role Plan administrator
Date 2011-03-09
Name of individual signing DAVID A. CARCIERI, M.D.
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/09/21/20100921103221P030004648353001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2005-04-06
Business code 621111
Sponsor’s telephone number 4013530757
Plan sponsor’s address 1637 MINERAL SPRING AVENUE, NORTH PROVIDENCE, RI, 02904

Plan administrator’s name and address
Administrator’s EIN 202628512
Plan administrator’s name DAVID A. CARCIERI, M.D., INC.
Plan administrator’s address 1637 MINERAL SPRING AVENUE, NORTH PROVIDENCE, RI, 02904
Administrator’s telephone number 4013530757

Signature of
Role Plan administrator
Date 2010-09-21
Name of individual signing DAVID A. CARCIERI, M.D.
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
STEPHEN D. ZUBIAGO, ESQ. Agent NIXON PEABODY LLP ONE CITIZENS PLAZA SUITE 500, PROVIDENCE, RI, 02903, USA

PRESIDENT

Name Role Address
DAVID A. CARCIERI, M.D. PRESIDENT 1637 MINERAL SPRING AVENUE, SUITE 211 NORTH PROVIDENCE, RI 02904 USA

Filings

Number Name File Date
202451362520 Annual Report 2024-04-17
202331878640 Annual Report 2023-03-27
202213647980 Annual Report 2022-03-24
202193546550 Annual Report 2021-03-03
202035464220 Annual Report 2020-02-26
201988073130 Annual Report 2019-02-27
201859567070 Annual Report 2018-02-28
201735056610 Annual Report 2017-02-27
201691581920 Annual Report 2016-02-01
201556107560 Annual Report 2015-03-02

Related by officers

STEPHEN D. ZUBIAGO, ESQ.

Nicholas A. Califano, M.D., Inc. CARDIOLOGY ASSOCIATES, INC. MIRIAM IPA, INC. ORTHOPEDIC GROUP, INC. Bayside Endoscopy Group, Inc. Mobile Storage Inc. H & H TRUCKING INC. MIRIAM PHO, INC. Bayside OB-GYN, Inc. West Bay Orthopaedics and Neurosurgery, Inc.

Related by address

1637 MINERAL SPRING AVENUE SUITE 211, NORTH PROVIDENCE, RI, 02904, USA

ERK REALTY, LLC

Date of last update: 09 Oct 2024

Sources: Rhode Island Department of State

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