# JASON IANNUCCILLI

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1659599868
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2085R0202X | Diagnostic Radiology Physician | 12595 | RI | — |
| 2085R0202X | Diagnostic Radiology Physician | A111724 | CA | — |
| 2085R0202X | Diagnostic Radiology Physician | LP00021 | RI | — |
| 2085R0202X | Diagnostic Radiology Physician | MD12595 | RI | — |
| 2085R0204X | Vascular & Interventional Radiology Physician | 12595 | RI | — |
| 2085R0204X | Vascular & Interventional Radiology Physician | MD12595 | RI | Yes |

## Other

- **Enumeration date:** 04/23/2007
- **Last updated:** 03/18/2019