Provider Demographics
NPI:1285690610
Name:ENANDER, MARK WARREN (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:WARREN
Last Name:ENANDER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 SCHOOL ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-5334
Mailing Address - Country:US
Mailing Address - Phone:401-725-8989
Mailing Address - Fax:401-312-0029
Practice Address - Street 1:333 SCHOOL ST
Practice Address - Street 2:SUITE 203
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-5334
Practice Address - Country:US
Practice Address - Phone:401-725-8989
Practice Address - Fax:401-312-0029
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00249213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI2257OtherNHOOD #
RI70665OtherBCBS OF RI
RI2700154OtherUNITED HEALTH
RI9007066Medicaid
RI203992OtherBLUECHIP
RI000249OtherTUFTS #
RIU08292Medicare UPIN
RI2700154OtherUNITED HEALTH