Provider Demographics
NPI:1386662138
Name:RIZZO, THOMAS JR (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:RIZZO
Suffix:JR
Gender:M
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 8500-6335
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0001
Mailing Address - Country:US
Mailing Address - Phone:215-807-8000
Mailing Address - Fax:215-807-8235
Practice Address - Street 1:3998 RED LION RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1436
Practice Address - Country:US
Practice Address - Phone:215-612-4000
Practice Address - Fax:215-807-8235
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD011964L207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0059918000OtherKEYSTONE IBC
PAPA0032668OtherTRICARE
PA28898OtherHEALTH PARTNERS
PA0015543260001Medicaid
PA0015543260002Medicaid
PA141426OtherPERSONAL CHOICE
PA0015543260007Medicaid
PA01554326-01OtherAMERICHOICE
PA141426OtherHIGHMARK BLUE SHIELD
PA2968422OtherAETNA CONTRACT
PA34008COtherKEYSTONE MERCY
PA6982997OtherCIGNA
PAC31573Medicare UPIN
PA0015543260007Medicaid