Individual
REX L MAHNENSMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
80 PHOENIX AVE, WATERBURY, CT 06702-1418
(203) 756-8021
(203) 596-9038
Mailing address
80 PHOENIX AVE, WATERBURY, CT 06702-1418
(203) 756-8021
(203) 596-9038
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
021731
CT
207RN0300X
Nephrology Physician
021731
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001217314
—
CT
Enumeration date
12/05/2005
Last updated
10/22/2015
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