Individual
CARL-CHRISTIAN ANDREW JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2 DUDLEY ST STE 190, PROVIDENCE, RI 02905-3248
(401) 228-0623
(401) 868-2319
Mailing address
15 LASALLE SQUARE, PROVIDENCE, RI 02903
(401) 444-3239
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
036-106668
IL
2086S0120X
Pediatric Surgery Physician
231415
MA
2086S0120X
Pediatric Surgery Physician
Primary
MD18790
RI
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
A88272
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A882720
—
CA
Enumeration date
04/18/2007
Last updated
11/26/2025
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