Individual
KENNETH A. WILLIAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
593 EDDY ST, CLAVERICK 2, PROVIDENCE, RI 02903-4923
(401) 519-1604
(401) 272-0538
Mailing address
PO BOX 9484, PROVIDENCE, RI 02940-9484
(401) 854-2500
(401) 854-2519
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
58081
MA
207P00000X
Emergency Medicine Physician
Primary
MD 09381
RI
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
58081
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04/01/2007
BCBS
RI
01
—
04/15/2009
UNITED HEALTHCARE
RI
01
—
11/12/2009
NHPRI
RI
01
—
12/29/2008
TUFTS HEALTH PLAN
MA
01
—
1316953458
NPI
RI
05
—
7005716
—
RI
01
—
939025129
RI MEDICARE GROUP NUMBER
RI
01
—
P00401949
RR MEDICARE
RI
Enumeration date
07/31/2006
Last updated
05/09/2023
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