Provider Demographics
NPI:1356342323
Name:DENNISON, ALLEN MANSFIELD (MD)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:MANSFIELD
Last Name:DENNISON
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 1:1180 HOPE ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:RI
Mailing Address - Zip Code:02809-1126
Mailing Address - Country:US
Mailing Address - Phone:401-253-8900
Mailing Address - Fax:401-253-3131
Practice Address - Street 1:286 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:RI
Practice Address - Zip Code:02806-3437
Practice Address - Country:US
Practice Address - Phone:404-247-0610
Practice Address - Fax:401-245-7362
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD 06104207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI04-00518OtherUNITED HEALTH CARE
RI3822OtherNEIGHBORHOOD HEALTH
RI406137OtherTUFTS HEALTH PLAN
RI0000000303OtherB/S
RI697704OtherHARVARD PILGRIM HEALTH
RI000630OtherBCHIP
RI110113980OtherRAILROAD MEDICARE
RIAD00546Medicaid
RI118000303Medicare PIN
RI110113980OtherRAILROAD MEDICARE
RI04-00518OtherUNITED HEALTH CARE