Provider Demographics
NPI:1316923352
Name:CHAVARRIA, JOHNNY (MD)
Entity type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:
Last Name:CHAVARRIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02889-1031
Mailing Address - Country:US
Mailing Address - Phone:401-737-4282
Mailing Address - Fax:401-738-6896
Practice Address - Street 1:161 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02889-1031
Practice Address - Country:US
Practice Address - Phone:401-737-4282
Practice Address - Fax:401-738-6896
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI8929208000000X
RIMD08929208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI204693OtherBCBS
AA41503OtherHARVARD PILGRIM INS
RI8929OtherSTATE LICENSE
RI204491OtherCHCP BLUE CHIP
582062OtherAETNA INS
1201179OtherUNITED HEALTH PLAN
RI3859OtherNEIGHBORHOOD HEALTH PLAN
RIJC32094Medicaid
AA41503OtherHARVARD PILGRIM INS