Graduated: 2009
NPI: 1164658043
Practice Locations (2)
PROSPECT CHARTERCARE RWMC, LLC
825 CHALKSTONE AVE
PROVIDENCE, RI 029084728
4014562026
PROSPECT CHARTERCARE RWMC, LLC
825 CHALKSTONE AVE
PROVIDENCE, RI 029084735
Source: CMS National Downloadable File, September 2026.