E.P. Mennillo, M.D., Inc

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

License

09221 Issued in RI

Legal business name

E.P. MENNILLO, M.D., INC

Practice address

994 Reservoir Ave
Cranston, RI 02910-5122

Phone

(401) 944-8422

Fax

(401) 942-6995

NPI assigned

Apr 10, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Roger Mennillo, M.D.

Title

President

Phone

(401) 944-8422

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1285857219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "994 RESERVOIR AVE",
            "city": "CRANSTON",
            "state": "RI",
            "postal_code": "029105122",
            "telephone_number": "401-944-8422",
            "fax_number": "401-942-6995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "994 RESERVOIR AVE",
            "city": "CRANSTON",
            "state": "RI",
            "postal_code": "029105122",
            "telephone_number": "401-944-8422",
            "fax_number": "401-942-6995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "E.P. MENNILLO, M.D., INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MENNILLO",
        "authorized_official_first_name": "ROGER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "401-944-8422",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "RI",
            "license": "03033",
            "primary": false
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "RI",
            "license": "09221",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Adolescent Medicine Physician in Cranston, RI
• Providers in Cranston, RI by specialty
• Pediatric Adolescent Medicine Physician in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.