Individual
NICHOLAS D IANNUCCILLI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1515 SMITH ST, STE 6, NORTH PROVIDENCE, RI 02911-2947
(401) 353-1600
Mailing address
1515 SMITH ST, STE 6, NORTH PROVIDENCE, RI 02911-2947
(401) 353-1600
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD04413
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004035
BLUECHIP
RI
01
—
11237
NEIGHBORHOOD HEALTH RI GR
—
01
—
245926
PILGRIM
—
01
—
3412
GROUP RI BLUE SHIELD
—
01
—
6145612
MASS WELFARE
—
05
—
7000911
—
RI
01
—
710442
TUFTS
—
Enumeration date
08/28/2006
Last updated
08/16/2016
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