Individual provider · Type 1 NPI

Carl-Christian Andrew Jackson, MD

Pediatric Surgery Physician · Providence, RI

NPI number 1235355173 Active

Practice location

2 Dudley St Ste 190
Providence, RI 02905-3248

Call (401) 228-0623 Map

Fax (401) 868-2319

Mailing address

15 Lasalle Square
Providence, RI 02903

Other practice locations

  • 725 Albany Street, Suite 8C, Shapiro Building, Boston, MA 02118 · (617) 414-5131
  • 750 Washington St, Tufts-Nemc #344, Boston, MA 02111-1526 · (617) 636-5025

Specialties and licenses

TaxonomyCodeLicense
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000XA88272 (CA)
Pediatric Surgery Physician Primary 2086S0120XMD18790 (RI)
Pediatric Surgery Physician 2086S0120X231415 (MA)
Surgery Physician 208600000X036-106668 (IL)

Pediatric Surgery Physician: A surgeon with expertise in the management of surgical conditions in premature and newborn infants, children and adolescents.

9 other providers at this address

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About NPI 1235355173

Carl-Christian Andrew Jackson, MD's National Provider Identifier is 1235355173, issued on Apr 18, 2007. The primary taxonomy on file is Pediatric Surgery Physician (2086S0120X), and the practice location is in Providence, RI. The record was last updated on Nov 26, 2025.