Organization
E.P. MENNILLO, M.D., INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROGER MENNILLO M.D. (PRESIDENT)
(401) 944-8422
Entity
Organization
Contact information
Practice address
994 RESERVOIR AVE, CRANSTON, RI 02910-5122
(401) 944-8422
(401) 942-6995
Mailing address
994 RESERVOIR AVE, CRANSTON, RI 02910-5122
(401) 944-8422
(401) 942-6995
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
03033
RI
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
09221
RI
Other
Enumeration date
04/10/2007
Last updated
08/22/2020
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