Provider Demographics
NPI:1811977804
Name:CARNEY-GODLEY, KATHLEEN (MD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:CARNEY-GODLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1672 S COUNTY TRL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-5098
Mailing Address - Country:US
Mailing Address - Phone:401-885-7546
Mailing Address - Fax:401-885-6640
Practice Address - Street 1:1672 S COUNTY TRL
Practice Address - Street 2:SUITE 101
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-5098
Practice Address - Country:US
Practice Address - Phone:401-885-7546
Practice Address - Fax:401-885-6640
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI8180207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI21995-0OtherBLUE CROSS BLUE SHIELD
RI070015494OtherRAILROAD MEDICARE
RIWE34797Medicaid
RI05051523930001OtherUNITED HEALTHCARE
RI401340OtherBLUE CHIP
RI070015494OtherRAILROAD MEDICARE
RIWE34797Medicaid