Provider Demographics
NPI:1164518742
Name:RIZZO, JOHN SAMUEL (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:SAMUEL
Last Name:RIZZO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MORTON AVENUE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RIDLEY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19078
Mailing Address - Country:US
Mailing Address - Phone:610-521-2111
Mailing Address - Fax:610-521-3048
Practice Address - Street 1:8 MORTON AVENUE
Practice Address - Street 2:SUITE 101
Practice Address - City:RIDLEY PARK
Practice Address - State:PA
Practice Address - Zip Code:19078
Practice Address - Country:US
Practice Address - Phone:610-521-2111
Practice Address - Fax:610-521-3048
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD021260E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA31269AOtherKEYSTONE MERCY HEALTH PLA
4131201OtherAETNA
PA0008385580001Medicaid
6424861BOtherCIGNA
PA0031054000OtherIBC-KEYSTONE HMO
180010183OtherRAILROAD MEDICARE
PAPS44146OtherOXFORD
PA166019OtherIBC
36784000OtherDAVIS VISION
P47921001OtherMULTIPLAN
PA31269AOtherKEYSTONE MERCY HEALTH PLA
PA0008385580001Medicaid