1891783759 NPI number — MARTHA B MAINIERO MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891783759 NPI number — MARTHA B MAINIERO MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

MAINIERO

Provider First Name:

MARTHA

Provider Middle Name:

B

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1891783759

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/15/2024

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

125 METRO CENTER BLVD STE 2000

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

WARWICK

Provider Business Mailing Address State Name:

RI

Provider Business Mailing Address Postal Code:

02886-1785

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

401-480-4877

Provider Business Mailing Address Fax Number:

401-432-2457

Provider First Line Business Practice Location Address:

593 EDDY ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

PROVIDENCE

Provider Business Practice Location Address State Name:

RI

Provider Business Practice Location Address Postal Code:

02903-4923

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

401-444-5174

Provider Business Practice Location Address Fax Number:

401-432-2457

Provider Enumeration Date:

10/13/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2085R0202X , with the licence number:  8846 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 2085R0202X , with the licence number: 160377 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 3202348 . This is a "HEALTHYSTART" identifier . This identifiers is of the category "OTHER".
• Identifier: 003112985 . This is a "CT MED ASSISTANCE" identifier . This identifiers is of the category "OTHER".
• Identifier: 005210 . This is a "BLUECHIP" identifier . This identifiers is of the category "OTHER".
• Identifier: 1600203 . This is a "UNITEDHEALTHPLANS" identifier . This identifiers is of the category "OTHER".
• Identifier: 008846 . This is a "BLUESHIELD" identifier . This identifiers is of the category "OTHER".
• Identifier: 7004724 . This is a "RIMEDICALASSISTANCE" identifier . This identifiers is of the category "OTHER".
• Identifier: 000000001988 . This is a "NHPRI" identifier . This identifiers is of the category "OTHER".
• Identifier: 007004727 . This is a "HOSPITALPIN" identifier . This identifiers is of the category "OTHER".
• Identifier: 240067 . This is a "RIHPILGRIM" identifier . This identifiers is of the category "OTHER".
• Identifier: 3202348 . This is a "MASSMEDICAID" identifier . This identifiers is of the category "OTHER".
• Identifier: 720053301 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 008846 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".