Individual
CHARLENE A ELLSWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
375 WAMPANOAG TRL, SUITE 301, RIVERSIDE, RI 02915-2232
(401) 649-4050
(401) 649-4051
Mailing address
110 ELM ST, PROVIDENCE, RI 02903-4626
(877) 771-7401
(401) 784-4902
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD14570
RI
Other
Enumeration date
07/09/2008
Last updated
03/01/2019
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