Search icon

West Bay Dermatology, Ltd.

Company Details

Name: West Bay Dermatology, Ltd.
Jurisdiction: Rhode Island
Entity type: Domestic Profit Corporation
Status: Dissolved
Date of Organization in Rhode Island: 29 Dec 2000 (24 years ago)
Date of Dissolution: 30 Jan 2017 (8 years ago)
Date of Status Change: 30 Jan 2017 (8 years ago)
Identification Number: 000116092
ZIP code: 02818
County: Kent County
Principal Address: 1672 SOUTH COUNTY TRAIL SUITE #202, EAST GREENWICH, RI, 02818, USA
Purpose: THE PRACTICE OF MEDICINE, INCLUDING BUT NOT LIMITED TO THE MEDICAL SPECIALITY OF DERMATOLOGY

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1841354982 2006-12-21 2010-08-25 1672 S COUNTY TRL STE 202, EAST GREENWICH, RI, 028185099, US 1672 S COUNTY TRL STE 202, EAST GREENWICH, RI, 028185099, US

Contacts

Phone +1 401-885-4100
Fax 4018854130

Authorized person

Name DR. CAROLINE S WILKEL
Role PARTNER
Phone 4018854100

Taxonomy

Taxonomy Code 174400000X - Specialist
Is Primary Yes

Other Provider Identifiers

Issuer RAILROAD MEDICARE
Number 070015999
State RI
Issuer BLUE CROSS BLUE SHIELD
Number 21994-1
State RI
Issuer MEDICAID
Number WE34797
State RI
Issuer BLUE CHIP
Number 202353
State RI

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
WEST BAY DERMATOLOGY, LTD. 401(K) PLAN 2015 050515239 2016-04-11 WEST BAY DERMATOLOGY, LTD. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-03-01
Business code 621111
Sponsor’s telephone number 4018854100
Plan sponsor’s address 1672 SOUTH COUNTY TRAIL, SUITE 202, EAST GREENWICH, RI, 02818

Signature of

Role Plan administrator
Date 2016-04-11
Name of individual signing DR. KATHLEEN CARNEY-GODLEY
Valid signature Filed with authorized/valid electronic signature
WEST BAY DERMATOLOGY, LTD. 2015 050515239 2016-04-11 WEST BAY DERMATOLOGY, LTD. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-03-01
Business code 621111
Sponsor’s telephone number 4018854100
Plan sponsor’s address 1672 SOUTH COUNTY TRAIL, SUITE 202, EAST GREENWICH, RI, 02818

Signature of

Role Plan administrator
Date 2016-04-11
Name of individual signing DR. KATHLEEN CARNEY-GODLEY
Valid signature Filed with authorized/valid electronic signature
WEST BAY DERMATOLOGY LTD. 401(K) PLAN 2015 050515239 2016-04-11 WEST BAY DERMATOLOGY, LTD. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-03-01
Business code 621111
Sponsor’s telephone number 4018854100
Plan sponsor’s address 1672 SO. COUNTY TRAIL, SUITE 202, EAST GREENWICH, RI, 02818

Signature of

Role Plan administrator
Date 2016-04-11
Name of individual signing DR. KATHLEEN CARNEY-GODLEY
Valid signature Filed with authorized/valid electronic signature
WEST BAY DERMATOLOGY LTD. 401(K) PLAN 2014 050515239 2015-09-04 WEST BAY DERMATOLOGY, LTD. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-03-01
Business code 621111
Sponsor’s telephone number 4018854100
Plan sponsor’s address 1672 SO. COUNTY TRAIL, SUITE 202, EAST GREENWICH, RI, 02818

Signature of

Role Plan administrator
Date 2015-09-04
Name of individual signing DR. KATHLEEN CARNEY-GODLEY
Valid signature Filed with authorized/valid electronic signature
WEST BAY DERMATOLOGY LTD. 401(K) PLAN 2013 050515239 2014-05-27 WEST BAY DERMATOLOGY, LTD. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-03-01
Business code 621111
Sponsor’s telephone number 4018854100
Plan sponsor’s address 1672 SO. COUNTY TRAIL, SUITE 202, EAST GREENWICH, RI, 02818

Plan administrator’s name and address

Administrator’s EIN 050515239
Plan administrator’s name WEST BAY DERMATOLOGY, LTD.
Plan administrator’s address 1672 SO. COUNTY TRAIL, SUITE 202, EAST GREENWICH, RI, 02818
Administrator’s telephone number 4018854100

Signature of

Role Plan administrator
Date 2014-05-27
Name of individual signing DR. KATHLEEN CARNEY-GODLEY
Valid signature Filed with authorized/valid electronic signature
WEST BAY DERMATOLOGY LTD. 401(K) PLAN 2012 050515239 2013-10-03 WEST BAY DERMATOLOGY, LTD. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-03-01
Business code 621111
Sponsor’s telephone number 4018854100
Plan sponsor’s address 1672 SO. COUNTY TRAIL, SUITE 202, EAST GREENWICH, RI, 02818

Plan administrator’s name and address

Administrator’s EIN 050515239
Plan administrator’s name WEST BAY DERMATOLOGY, LTD.
Plan administrator’s address 1672 SO. COUNTY TRAIL, SUITE 202, EAST GREENWICH, RI, 02818
Administrator’s telephone number 4018854100

Signature of

Role Plan administrator
Date 2013-10-03
Name of individual signing DR. KATHLEEN CARNEY-GODLEY
Valid signature Filed with authorized/valid electronic signature
WEST BAY DERMATOLOGY LTD. 401(K) PLAN 2011 050515239 2012-09-19 WEST BAY DERMATOLOGY, LTD. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-03-01
Business code 621111
Sponsor’s telephone number 4018854100
Plan sponsor’s address 1672 SO. COUNTY TRAIL, SUITE 202, EAST GREENWICH, RI, 02818

Plan administrator’s name and address

Administrator’s EIN 050515239
Plan administrator’s name WEST BAY DERMATOLOGY, LTD.
Plan administrator’s address 1672 SO. COUNTY TRAIL, SUITE 202, EAST GREENWICH, RI, 02818
Administrator’s telephone number 4018854100

Signature of

Role Plan administrator
Date 2012-09-19
Name of individual signing DR. KATHLEEN CARNEY-GODLEY
Valid signature Filed with authorized/valid electronic signature
WEST BAY DERMATOLOGY LTD. 401(K) PLAN 2010 050515239 2011-06-20 WEST BAY DERMATOLOGY, LTD. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-03-01
Business code 621111
Sponsor’s telephone number 4018854100
Plan sponsor’s address 1672 SO. COUNTY TRAIL, SUITE 202, EAST GREENWICH, RI, 02818

Plan administrator’s name and address

Administrator’s EIN 050515239
Plan administrator’s name WEST BAY DERMATOLOGY, LTD.
Plan administrator’s address 1672 SO. COUNTY TRAIL, SUITE 202, EAST GREENWICH, RI, 02818
Administrator’s telephone number 4018854100

Signature of

Role Plan administrator
Date 2011-06-20
Name of individual signing DR. KATHLEEN CARNEY-GODLEY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-06-20
Name of individual signing DR. KATHLEEN CARNEY-GODLEY
Valid signature Filed with authorized/valid electronic signature
WEST BAY DERMATOLOGY LTD. 401(K) PLAN 2009 050515239 2010-10-08 WEST BAY DERMATOLOGY, LTD. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-03-01
Business code 621111
Sponsor’s telephone number 4018854100
Plan sponsor’s address 1672 SO. COUNTY TRAIL, SUITE 202, EAST GREENWICH, RI, 02818

Plan administrator’s name and address

Administrator’s EIN 050515239
Plan administrator’s name WEST BAY DERMATOLOGY, LTD.
Plan administrator’s address 1672 SO. COUNTY TRAIL, SUITE 202, EAST GREENWICH, RI, 02818
Administrator’s telephone number 4018854100

Signature of

Role Plan administrator
Date 2010-10-08
Name of individual signing CAROL LIPMAN
Valid signature Filed with authorized/valid electronic signature

PRESIDENT

Name Role Address
KATHLEEN CARNEY-GODLEY MD PRESIDENT 28 LANDS END DRIVE NORTH KINGSTOWN, RI 02852- USA

VICE PRESIDENT

Name Role Address
CAROLINE SUSAN WILKEL MD VICE PRESIDENT 20 MAWNEY BROOK DRIVE EAST GREENWICH, RI 02818 USA

Filings

Number Name File Date
202191559200 Agent Resigned 2021-02-16
201731033840 Articles of Dissolution 2017-01-30
201690765150 Annual Report 2016-01-15
201554120110 Annual Report 2015-01-23
201433050730 Annual Report 2014-01-15
201307946110 Annual Report 2013-01-07
201288319550 Annual Report 2012-01-23
201173406060 Annual Report 2011-01-12
201057267510 Annual Report 2010-01-22
200941684590 Annual Report 2009-02-07

Date of last update: 08 Oct 2024

Sources: Rhode Island Department of State