Provider Demographics
NPI:1982770764
Name:MANNARELLI, LEONARD ANTHONY (DO)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:ANTHONY
Last Name:MANNARELLI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 312
Mailing Address - Street 2:
Mailing Address - City:PASCOAG
Mailing Address - State:RI
Mailing Address - Zip Code:02859-0312
Mailing Address - Country:US
Mailing Address - Phone:401-567-0800
Mailing Address - Fax:401-567-0900
Practice Address - Street 1:35 VILLAGE PLAZA
Practice Address - Street 2:
Practice Address - City:NORTH SCITUATE
Practice Address - State:RI
Practice Address - Zip Code:02857-1849
Practice Address - Country:US
Practice Address - Phone:401-647-6262
Practice Address - Fax:401-647-6201
Is Sole Proprietor?:No
Enumeration Date:2006-11-25
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO452207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine