Organization
NICHOLAS IANNUCCILLI MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICHOLAS IANNUCCILLI MD (PRESIDENT)
(401) 353-1600
Entity
Organization
Contact information
Practice address
1515 SMITH ST, NORTH PROVIDENCE, RI 02911-2947
(401) 353-1600
Mailing address
91 STILES RD, SALEM, NH 03079-2846
(603) 893-9784
(603) 893-8886
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000000763
BCBS
RI
05
—
9000763
—
RI
Enumeration date
11/29/2007
Last updated
02/15/2008
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