Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | MD14967 | RI |
N | 208000000X | Pediatrician | 043923 | CT |
N | 208000000X | Pediatrician | MD14967 | RI |
N | 208000000X | Pediatrician | MD430976 | PA |
Y | 2080P0204X | Pediatric Emergency Doctor | MD14967 | RI |
NPI | 1235180852 |
---|---|
Provider Name | Mark Robert Zonfrillo |
First Address | Providence, RI 02908-3258 |
Second Address | Providence, RI 02903-4923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 22/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110102928A | (05) | MA |
1235180852 | (05) | RI |
U400222345 | MEDICAR-NGS (01) | RI |