Provider Demographics
NPI:1811095706
Name:COLANNINO, DAVID M (DPM)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:COLANNINO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 SANDERSON RD
Mailing Address - Street 2:STE 104
Mailing Address - City:SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02917-2611
Mailing Address - Country:US
Mailing Address - Phone:401-949-3220
Mailing Address - Fax:401-949-3296
Practice Address - Street 1:41 SANDERSON RD
Practice Address - Street 2:SUITE 207
Practice Address - City:SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02917-2602
Practice Address - Country:US
Practice Address - Phone:401-949-3220
Practice Address - Fax:401-949-3296
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDPM232213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
489004216OtherMEDICARE GROUP
RI9D25829Medicaid
RI007057772Medicare ID - Type UnspecifiedIND
RI9D25829Medicaid