Provider Demographics
NPI:1750385092
Name:PIVA, KENNETH J (DO)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:J
Last Name:PIVA
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Gender:M
Credentials:DO
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Mailing Address - Street 1:200 MILL ROAD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:1565 N MAIN ST
Practice Address - Street 2:SUITE 306
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-2972
Practice Address - Country:US
Practice Address - Phone:508-973-9500
Practice Address - Fax:508-973-0351
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2020-04-23
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Provider Licenses
StateLicense IDTaxonomies
MA60524207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110056517AMedicaid
RIKP13640Medicaid
MAA2042401Medicare PIN