Individual
PAVINARMATHA KETHEESWARAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
40 CANDACE ST, PROVIDENCE, RI 02908-3747
(401) 444-0550
(401) 444-0425
Mailing address
375 ALLENS AVE, PROVIDENCE, RI 02905-5010
(401) 444-0400
(401) 444-0468
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
LP04636
RI
207Q00000X
Family Medicine Physician
Primary
MD18615
RI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/25/2019
Last updated
12/13/2023
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