Healthcare Provider Details

I. General information

NPI: 1285690610
Provider Name (Legal Business Name): MARK WARREN ENANDER D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 SCHOOL ST SUITE 203
PAWTUCKET RI
02860-5334
US

IV. Provider business mailing address

333 SCHOOL ST SUITE 203
PAWTUCKET RI
02860-5334
US

V. Phone/Fax

Practice location:
  • Phone: 401-725-8989
  • Fax: 401-312-0029
Mailing address:
  • Phone: 401-725-8989
  • Fax: 401-312-0029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number00249
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: