Provider Demographics
NPI:1093701948
Name:MARIORENZI, MICHAEL PETER (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PETER
Last Name:MARIORENZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 RESERVOIR AVE
Mailing Address - Street 2:#101
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-4448
Mailing Address - Country:US
Mailing Address - Phone:401-944-3800
Mailing Address - Fax:401-944-1342
Practice Address - Street 1:725 RESERVOIR AVE
Practice Address - Street 2:#101
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-4448
Practice Address - Country:US
Practice Address - Phone:401-944-3800
Practice Address - Fax:401-944-1342
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2010-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD07595207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1093701948OtherDURABLE EQUIPMENT
RI32166-6OtherRI BLUE CROSS
RI7000833Medicaid
RI208194OtherBLUE CHIP
RI208194OtherBLUE CHIP
RI007000833Medicare PIN