Provider Demographics
NPI:1891783759
Name:MAINIERO, MARTHA B (MD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:B
Last Name:MAINIERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:125 METRO CENTER BLVD STE 2000
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1785
Mailing Address - Country:US
Mailing Address - Phone:401-480-4877
Mailing Address - Fax:401-432-2457
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-444-5174
Practice Address - Fax:401-432-2457
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI88462085R0202X
MA1603772085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3202348OtherHEALTHYSTART
003112985OtherCT MED ASSISTANCE
005210OtherBLUECHIP
1600203OtherUNITEDHEALTHPLANS
008846OtherBLUESHIELD
7004724OtherRIMEDICALASSISTANCE
000000001988OtherNHPRI
007004727OtherHOSPITALPIN
240067OtherRIHPILGRIM
3202348OtherMASSMEDICAID
720053301OtherCIGNA
008846OtherTUFTS