41D0084679 CLIA NUMBER - CHARLES J DE ANGELIS MD

Laboratory Demographics

CLIA Number: 41D0084679

Facility Name: CHARLES J DE ANGELIS MD

Facility Address:
1199 RESERVOIR AVE
CRANSTON, RI
ZIP 02920
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Facility Phone Number: 401 942-4700

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1801904180

Taxonomy: 2085R0202X - Radiology
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

CLIA Record

Field Name	Field Value
CLIA Number	41D0084679
LAB Type	Physician Office
Facility Name	CHARLES J DE ANGELIS MD
Street	1199 RESERVOIR AVE
City	CRANSTON
State	RI
ZIP	02920
Phone	401 942-4700
CertificateType	4
CertificateEffectiveDate	6/28/2022
CertificateExpirationDate	6/27/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024