Provider Demographics
NPI:1326300914
Name:PETRUCCELLI, MARIANNE REED (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIANNE
Middle Name:REED
Last Name:PETRUCCELLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARIANNE
Other - Middle Name:SULLIVAN
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2 1/2 BEACON ST STE 199
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-4447
Mailing Address - Country:US
Mailing Address - Phone:603-228-2152
Mailing Address - Fax:603-225-2510
Practice Address - Street 1:248 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301
Practice Address - Country:US
Practice Address - Phone:603-225-0425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH187502085R0202X
CT0562732085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology