Individual
MR. KENNETH A FURCOLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
285 PROMENADE ST, PROVIDENCE, RI 02908-5719
(401) 459-4001
(401) 459-4006
Mailing address
285 PROMENADE ST, PROVIDENCE, RI 02908-5719
(401) 777-7000
(401) 459-4006
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA00067
RI
363AS0400X
Surgical Physician Assistant
PA00067
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20622
BLUE CROSS
RI
01
—
406284
BLUE CHIP
RI
Enumeration date
10/23/2006
Last updated
08/19/2021
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