Provider Demographics
NPI:1477579407
Name:MANCINI, MARK J (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:MANCINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:268 POST RD STE 204
Mailing Address - Street 2:
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-6601
Mailing Address - Country:US
Mailing Address - Phone:401-596-3313
Mailing Address - Fax:401-596-2650
Practice Address - Street 1:268 POST RD STE 204
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-6601
Practice Address - Country:US
Practice Address - Phone:401-596-3313
Practice Address - Fax:401-596-2650
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD 10090207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIMD 10090OtherSTATE MEDICAL LICENSE
RIMD 10090OtherSTATE MEDICAL LICENSE