Individual
ROGER NILES MENNILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
176 TOLL GATE RD, SUITE 101, WARWICK, RI 02886-4482
(401) 737-9270
(401) 739-6413
Mailing address
10 DAVOL SQ, SUITE 400, PROVIDENCE, RI 02903-4754
(401) 421-4000
(401) 272-1456
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD09221
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
RM51805
—
RI
Enumeration date
02/23/2006
Last updated
04/04/2024
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