Individual
JASON IANNUCCILLI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
125 METRO CENTER BLVD STE 2000, WARWICK, RI 02886-1785
(401) 432-2520
Mailing address
125 METRO CENTER BLVD STE 2000, WARWICK, RI 02886-1785
(401) 432-2520
Taxonomy
Speciality
Code
Description
License number
State
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
Primary
MD12595
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0A1117240
—
CA
05
—
J185324
—
RI
Enumeration date
04/23/2007
Last updated
03/18/2019
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