Provider Demographics
NPI:1689650327
Name:SALZSIEDER, KENNETH H (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:H
Last Name:SALZSIEDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 MENDON RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-4337
Mailing Address - Country:US
Mailing Address - Phone:401-334-2423
Mailing Address - Fax:401-334-9808
Practice Address - Street 1:470 TOLL GATE RD
Practice Address - Street 2:SUITE 205
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2741
Practice Address - Country:US
Practice Address - Phone:401-739-3044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD05164207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0005434Medicaid
RIC90502Medicare UPIN
RI118000543Medicare PIN