Provider Demographics
NPI:1386140721
Name:ASTROW, JARED (DO)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:ASTROW
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 WARREN AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-1430
Mailing Address - Country:US
Mailing Address - Phone:401-330-2488
Mailing Address - Fax:401-330-2483
Practice Address - Street 1:900 WARREN AVE STE 401
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-1430
Practice Address - Country:US
Practice Address - Phone:401-330-2488
Practice Address - Fax:401-330-2483
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-04
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO01287207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine