Provider Demographics
NPI:1659913549
Name:BRIAN G KWETKOWSKI
Entity Type:Organization
Organization Name:BRIAN G KWETKOWSKI
Other - Org Name:DR BRIAN KWETKOWSKI DO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:KWETKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:401-471-6510
Mailing Address - Street 1:3461 S COUNTY TRL STE 303
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-1463
Mailing Address - Country:US
Mailing Address - Phone:401-471-6510
Mailing Address - Fax:401-471-6530
Practice Address - Street 1:3461 S COUNTY TRL STE 303
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-1463
Practice Address - Country:US
Practice Address - Phone:401-471-6510
Practice Address - Fax:401-471-6530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-11
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty