# E.P. MENNILLO, M.D., INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285857219
- **Authorized official:** DR. ROGER MENNILLO M.D. (PRESIDENT)
- **Authorized official phone:** (401) 944-8422

## Contact information

- **Practice address:** 994 RESERVOIR AVE, CRANSTON, RI 02910-5122
- **Practice address phone:** (401) 944-8422
- **Practice address fax:** (401) 942-6995
- **Mailing address:** 994 RESERVOIR AVE, CRANSTON, RI 02910-5122
- **Mailing address phone:** (401) 944-8422
- **Mailing address fax:** (401) 942-6995

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2080A0000X | Pediatric Adolescent Medicine Physician | 03033 | RI | — |
| 2080A0000X | Pediatric Adolescent Medicine Physician | 09221 | RI | Yes |

## Other

- **Enumeration date:** 04/10/2007
- **Last updated:** 08/22/2020