CARL-CHRISTIAN ANDREW JACKSON MD NPI 1235355173

NPI Information

NPI: 1235355173
Provider Name: CARL-CHRISTIAN ANDREW JACKSON, MD
Classification: Surgery - 2086S0120X
Specialization: Pediatric Surgery
Entity Type: Individual
PECOS Registration: Yes
Address: 2 DUDLEY ST STE 190
PROVIDENCE, RI
ZIP 02905
Phone: (401) 228-0623

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NPI Details

Carl-christian Andrew Jackson, MD is a pediatric surgery surgery in Providence, RI. The provider is a surgeon with expertise in the management of surgical conditions in premature and newborn infants, children and adolescents. Carl-christian Andrew Jackson, MD NPI is 1235355173. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

2 DUDLEY ST STE 190
PROVIDENCE, RI
ZIP 02905-248
Phone: (401) 228-0623
Fax: (401) 868-2319

The NPI 1235355173 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 4/18/2007 and was last updated on 11/26/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery)		A88272	CALIFORNIA	No
2	2086S0120X	Surgery	Pediatric Surgery	MD18790	RHODE ISLAND	Yes
3	2086S0120X	Surgery	Pediatric Surgery	231415	MASSACHUSETTS	No
4	208600000X	Surgery		036-106668	ILLINOIS	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	00A882720	MEDICAID	CALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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