Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 00249 | RI |
NPI | 1285690610 |
---|---|
Provider Name | Dr. Mark Warren Enander |
First Address | Pawtucket, RI 02860-5334 |
Second Address | Pawtucket, RI 02860-5334 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 17/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000249 | TUFTS # (01) | RI |
203992 | BLUECHIP (01) | RI |
2257 | NHOOD # (01) | RI |
2700154 | UNITED HEALTH (01) | RI |
70665 | BCBS OF RI (01) | RI |
9007066 | (05) | RI |
U08292 | (02) | RI |