Healthcare Provider Details

I. General information

NPI: 1245466390
Provider Name (Legal Business Name): PENNY KADMON,M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2009
Last Update Date: 12/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 RESERVOIR AVE SUITE 306
CRANSTON RI
02910-4448
US

IV. Provider business mailing address

PO BOX 2337
PROVIDENCE RI
02906-0337
US

V. Phone/Fax

Practice location:
  • Phone: 401-780-5557
  • Fax:
Mailing address:
  • Phone: 401-780-5557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberMD09667
License Number StateRI

VIII. Authorized Official

Name: DR. PENNY KADMON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 401-780-5557