Healthcare Provider Details

I. General information

NPI: 1710674247
Provider Name (Legal Business Name): PRANALI ASHOK KERKAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 W RIVER ST FL 3
PROVIDENCE RI
02904-2609
US

IV. Provider business mailing address

15 LA SALLE SQ
PROVIDENCE RI
02903-1814
US

V. Phone/Fax

Practice location:
  • Phone: 401-793-7010
  • Fax: 401-793-7988
Mailing address:
  • Phone: 401-444-6779
  • Fax: 401-444-6912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD21123
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: