Basic Information
| Provider Information | |||||||||
| NPI: | 1528013224 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROWE | ||||||||
| FirstName: | KERRY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 229 | ||||||||
| Address2: | |||||||||
| City: | WAKEFIELD | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028800229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017883337 | ||||||||
| FaxNumber: | 4017883939 | ||||||||
| Practice Location | |||||||||
| Address1: | 3461 S COUNTY TRL | ||||||||
| Address2: | |||||||||
| City: | EAST GREENWICH | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028181465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014716740 | ||||||||
| FaxNumber: | 4014716753 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 03/22/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 215393 | MA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | MD14269 | RI | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | J25190 | 01 | MA | BLUE SHIELD | OTHER | 0180017 | 05 | MA | MEDICAID |