Provider Demographics
NPI:1386659019
Name:BRANCATO, MARK R (LICAC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:BRANCATO
Suffix:
Gender:M
Credentials:LICAC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:125 MIDWAY RD #306
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920
Mailing Address - Country:US
Mailing Address - Phone:401-439-7116
Mailing Address - Fax:401-941-5128
Practice Address - Street 1:95 SOCKANOSSET CROSS RD STE 101
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920
Practice Address - Country:US
Practice Address - Phone:401-439-7116
Practice Address - Fax:401-941-5120
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDA00145171100000X
RI00071171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist