Healthcare Provider Details

I. General information

NPI: 1689650327
Provider Name (Legal Business Name): KENNETH H SALZSIEDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 08/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 TOLL GATE RD SUITE 205
WARWICK RI
02886-2741
US

IV. Provider business mailing address

1725 MENDON RD
CUMBERLAND RI
02864-4337
US

V. Phone/Fax

Practice location:
  • Phone: 401-739-3044
  • Fax:
Mailing address:
  • Phone: 401-334-2423
  • Fax: 401-334-9808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD05164
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: