Healthcare Provider Details

I. General information

NPI: 1912189002
Provider Name (Legal Business Name): KENNETH H. SALZSIEDER,MD LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 10/23/2014
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

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

V. Phone/Fax

Practice location:
  • Phone: 401-739-3044
  • Fax: 401-738-1511
Mailing address:
  • Phone: 401-739-3044
  • Fax: 401-738-1511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. KENNETH H SALZSIEDER
Title or Position: MD
Credential: MD
Phone: 401-739-3044