Provider Demographics
NPI:1215047618
Name:NENONEN, RITA (MD)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:NENONEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9484
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02940-9484
Mailing Address - Country:US
Mailing Address - Phone:401-854-2500
Mailing Address - Fax:401-854-2519
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:CLAVERICK 2
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-854-2504
Practice Address - Fax:401-854-2519
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD05716207QA0000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA12/29/2008OtherTUFTS HEALTH PLAN
RI11/12/2009OtherNHPRI
RI007008106OtherMEDICARE - TYPE UNSPECIFI
RI10/01/2008OtherBCBS
RI1215047618OtherNPI
RI04/15/2009OtherUNITED HEALTH CARE
RI7002203Medicaid
RI939025129OtherRI MEDICARE GROUP NUMBER
MA3206211Medicaid
RI1215047618OtherNPI