Organization
PROSPECT CHARTERCARE PHYSICIANS, LLC
Active
Other names
CharterCARE Medical Associates
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT JON ELDERS (SECRETARY)
(714) 788-1249
Entity
Organization
Contact information
Practice address
1681 CRANSTON ST, CRANSTON, RI 02920-5000
(401) 944-6889
(401) 944-6726
Mailing address
825 CHALKSTONE AVE, PROVIDENCE, RI 02908-4728
(401) 456-2025
(401) 456-2029
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
—
—
133VN1006X
Metabolic Nutrition Registered Dietitian
—
—
207N00000X
Dermatology Physician
PR98473
RI
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
207RH0003X
Hematology & Oncology Physician
—
—
207RI0200X
Infectious Disease Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
207T00000X
Neurological Surgery Physician
—
—
2084N0400X
Neurology Physician
—
—
208600000X
Surgery Physician
—
—
208800000X
Urology Physician
—
—
Other
Enumeration date
02/20/2014
Last updated
07/15/2025
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