Healthcare Provider Details

I. General information

NPI: 1316953458
Provider Name (Legal Business Name): KENNETH A. WILLIAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST CLAVERICK 2
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

PO BOX 9484
PROVIDENCE RI
02940-9484
US

V. Phone/Fax

Practice location:
  • Phone: 401-519-1604
  • Fax: 401-272-0538
Mailing address:
  • Phone: 401-854-2500
  • Fax: 401-854-2519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD 09381
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number58081
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number58081
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: