Provider Demographics
NPI:1396776266
Name:LONGACRE, MARIANNE T (DO)
Entity type:Individual
Prefix:MS
First Name:MARIANNE
Middle Name:T
Last Name:LONGACRE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:45 WELLS ST STE 201
Mailing Address - Street 2:
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-2927
Mailing Address - Country:US
Mailing Address - Phone:401-637-7202
Mailing Address - Fax:860-865-2393
Practice Address - Street 1:45 WELLS ST STE 201
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-2927
Practice Address - Country:US
Practice Address - Phone:401-637-7202
Practice Address - Fax:860-865-2393
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIDO00537207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1396776266Medicaid
RI1396776266Medicaid