Healthcare Provider Details

I. General information

NPI: 1982770764
Provider Name (Legal Business Name): LEONARD ANTHONY MANNARELLI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2006
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 VILLAGE PLAZA
NORTH SCITUATE RI
02857-1849
US

IV. Provider business mailing address

PO BOX 312
PASCOAG RI
02859-0312
US

V. Phone/Fax

Practice location:
  • Phone: 401-647-6262
  • Fax: 401-647-6201
Mailing address:
  • Phone: 401-567-0800
  • Fax: 401-567-0900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDO452
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: