Provider Demographics
NPI:1972784452
Name:CZERWEIN, JOHN JR (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:CZERWEIN
Suffix:JR
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 1:1524 ATWOOD AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-3228
Mailing Address - Country:US
Mailing Address - Phone:401-351-6200
Mailing Address - Fax:401-351-6201
Practice Address - Street 1:1524 ATWOOD AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-3228
Practice Address - Country:US
Practice Address - Phone:401-351-6200
Practice Address - Fax:401-351-6201
Is Sole Proprietor?:No
Enumeration Date:2007-11-26
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD12647207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
7508801243OtherSELECTIVE SERVICE
RIJC72321Medicaid