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General NPI Number Information
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NPI Number | 1659913549
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Entity Type | Organization
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Legal Business Name | BRIAN G KWETKOWSKI
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Dates
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Enumeration Date | 10/11/2019
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Last Update Date | 11/14/2019
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Provider Practice Location Address
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Address Line | 3461 S COUNTY TRL STE 303
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City | EAST GREENWICH
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State | RI
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Zip | 02818-1463
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Country | US
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Telephone | 401-471-6510
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Fax | 401-471-6530
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Provider Business Mailing Address
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Address Line | 3461 S COUNTY TRL STE 303
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City | EAST GREENWICH
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State | RI
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Zip | 02818-1463
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Country | US
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Telephone | 401-471-6510
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Fax | 401-471-6530
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Authorized Official
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Title or Position | OWNER/ PHYSICIAN
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Name | BRIAN G KWETKOWSKI
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Credential | DO
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Telephone | 401-471-6510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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