MEDICARE: REX L MAHNENSMITH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	021731	CT
2	207R00000X	Internal Medicine Physician	021731	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760466528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REX L MAHNENSMITH M.D.

Provider Business Mailing Address
First Line	:	80 PHOENIX AVE
Second Line	:
City	:	WATERBURY
State	:	CT
Zip	:	06702-1418
Country	:	US
Telephone Number	:	203-756-8021
Fax Number	:	203-596-9038

Provider Business Practice Location Address
First Line	:	80 PHOENIX AVE
Second Line	:
City	:	WATERBURY
State	:	CT
Zip	:	06702-1418
Country	:	US
Telephone Number	:	203-756-8021
Fax Number	:	203-596-9038

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	10/22/2015

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