Provider Demographics
NPI:1134388820
Name:LEONARD A MANNARELLI II, D.O. INC.
Entity type:Organization
Organization Name:LEONARD A MANNARELLI II, D.O. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:MANNARELLI
Authorized Official - Suffix:II
Authorized Official - Credentials:DO
Authorized Official - Phone:401-944-1748
Mailing Address - Street 1:135 ATWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-4131
Mailing Address - Country:US
Mailing Address - Phone:401-944-1748
Mailing Address - Fax:401-944-1746
Practice Address - Street 1:135 ATWOOD AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-4131
Practice Address - Country:US
Practice Address - Phone:401-944-1748
Practice Address - Fax:401-944-1746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO452207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI007010471Medicare PIN