Provider Demographics
NPI:1477615995
Name:MIRIAM CARDIOLOGY, INC.
Entity Type:Organization
Organization Name:MIRIAM CARDIOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:S
Authorized Official - Last Name:KORR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-793-7191
Mailing Address - Street 1:208 COLLYER STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904
Mailing Address - Country:US
Mailing Address - Phone:401-793-7191
Mailing Address - Fax:401-793-7200
Practice Address - Street 1:208 COLLYER STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904
Practice Address - Country:US
Practice Address - Phone:401-793-7191
Practice Address - Fax:401-793-7200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD5815207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty