Provider Demographics
NPI:1265540868
Name:MANCINI, THOMAS E (DPM, FAC, FAS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:MANCINI
Suffix:
Gender:M
Credentials:DPM, FAC, FAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 MAIN ST
Mailing Address - Street 2:SUITE 21
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818
Mailing Address - Country:US
Mailing Address - Phone:401-885-6090
Mailing Address - Fax:401-885-6091
Practice Address - Street 1:1050 MAIN ST
Practice Address - Street 2:SUITE 21
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818
Practice Address - Country:US
Practice Address - Phone:401-885-6090
Practice Address - Fax:401-885-6091
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDPM00247213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI70786OtherBLUE CROSS BLUE SHIELD
RI2700181OtherUNITED HEALTH CARE
RI9007078Medicaid
RI488007078Medicare ID - Type Unspecified
RI70786OtherBLUE CROSS BLUE SHIELD
RI007004321Medicare ID - Type Unspecified