Healthcare Provider Details

I. General information

NPI: 1194710814
Provider Name (Legal Business Name): LOUIS JOHN MARIORENZI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 08/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 RESERVOIR AVE #101
CRANSTON RI
02910-4448
US

IV. Provider business mailing address

725 RESERVOIR AVE #101
CRANSTON RI
02910-4448
US

V. Phone/Fax

Practice location:
  • Phone: 401-944-3800
  • Fax: 401-944-1342
Mailing address:
  • Phone: 401-944-3800
  • Fax: 401-944-1342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD06047
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: