Provider Demographics
NPI:1023132099
Name:MANCINI, MELVIN J (DPM)
Entity type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:J
Last Name:MANCINI
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 1:345 ARMISTICE BLVD
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02861-2429
Mailing Address - Country:US
Mailing Address - Phone:401-725-5576
Mailing Address - Fax:401-725-2640
Practice Address - Street 1:345 ARMISTICE BLVD
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02861-2429
Practice Address - Country:US
Practice Address - Phone:401-725-5576
Practice Address - Fax:401-725-2640
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDPM00204213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI4970910001Medicare NSC
RI007060180Medicare PIN