Provider Demographics
NPI:1861151409
Name:CARVALHO, SCOTT M
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:M
Last Name:CARVALHO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 RICHMOND ST # 103
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4222
Mailing Address - Country:US
Mailing Address - Phone:401-430-2200
Mailing Address - Fax:
Practice Address - Street 1:300 RICHMOND ST # 103
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4222
Practice Address - Country:US
Practice Address - Phone:401-430-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker