Provider Demographics
NPI:1942263942
Name:MARINELLI, DAVID L (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:MARINELLI
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 1:9 OVERBROOK LN
Mailing Address - Street 2:
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-2509
Mailing Address - Country:US
Mailing Address - Phone:413-567-2164
Mailing Address - Fax:413-567-2164
Practice Address - Street 1:9 OVERBROOK LN
Practice Address - Street 2:
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-2509
Practice Address - Country:US
Practice Address - Phone:413-567-2164
Practice Address - Fax:413-567-2164
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA590522085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3034542Medicaid
MAB98164Medicare UPIN
MA3034542Medicaid