Provider Demographics
NPI:1023065711
Name:KWETKOWSKI, ELENA M (DO)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:M
Last Name:KWETKOWSKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 RIDGEVALE CT
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02921-1444
Mailing Address - Country:US
Mailing Address - Phone:401-828-5335
Mailing Address - Fax:401-828-3914
Practice Address - Street 1:191 MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816-7244
Practice Address - Country:US
Practice Address - Phone:401-828-5335
Practice Address - Fax:401-828-2914
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209812207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine