Provider Demographics
NPI:1154311314
Name:PIZZARELLO, MARTHA A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:A
Last Name:PIZZARELLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARTHA
Other - Middle Name:A
Other - Last Name:DEPETERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:297 PROMENADE ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-5720
Mailing Address - Country:US
Mailing Address - Phone:401-490-6464
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:297 PROMENADE ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-5720
Practice Address - Country:US
Practice Address - Phone:401-490-6464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD12397207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2045061Medicaid
MA468924OtherTUFTS HEALTH PLAN
MAJ27388OtherBCBS MA
MA2045061Medicaid
MAA37233Medicare ID - Type Unspecified