Healthcare Provider Details

I. General information

NPI: 1912946658
Provider Name (Legal Business Name): DAVID KADMON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 05/27/2020
Certification Date: 05/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 OLD RIVER RD SUITE B-2
LINCOLN RI
02865-1161
US

IV. Provider business mailing address

PO BOX 9244
PROVIDENCE RI
02940-9244
US

V. Phone/Fax

Practice location:
  • Phone: 401-333-2784
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD09598
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD109667
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: