Healthcare Provider Details

I. General information

NPI: 1811977804
Provider Name (Legal Business Name): KATHLEEN CARNEY-GODLEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1672 S COUNTY TRL SUITE 101
EAST GREENWICH RI
02818-5098
US

IV. Provider business mailing address

1672 S COUNTY TRL SUITE 101
EAST GREENWICH RI
02818-5098
US

V. Phone/Fax

Practice location:
  • Phone: 401-885-7546
  • Fax: 401-885-6640
Mailing address:
  • Phone: 401-885-7546
  • Fax: 401-885-6640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberRI8180
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: