Provider Demographics
NPI:1902819402
Name:PRIOLO, DENNIS L (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:L
Last Name:PRIOLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 MINERAL SPRING AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-7645
Mailing Address - Country:US
Mailing Address - Phone:401-354-4900
Mailing Address - Fax:401-354-8535
Practice Address - Street 1:115 CASS AVE
Practice Address - Street 2:HOSPITAL BASED - LANDMARK MEDICAL CENTER
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895
Practice Address - Country:US
Practice Address - Phone:401-769-4100
Practice Address - Fax:401-767-1631
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD077302085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI3412OtherGROUP BLUE SHIELD
31237OtherNEIGHBORHOOD HEALTH GRP
RI7007112Medicaid
RI405174OtherBLUECHIP
RI3412OtherGROUP BLUE SHIELD