Provider Demographics
NPI:1407824659
Name:RITZ, JEROME (MD)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:
Last Name:RITZ
Suffix:
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 1:450 BROOKLINE AVE
Mailing Address - Street 2:M530, DANA-FARBER CANCER INSTITUTE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5418
Mailing Address - Country:US
Mailing Address - Phone:617-632-3465
Mailing Address - Fax:617-632-5167
Practice Address - Street 1:450 BROOKLINE AVE
Practice Address - Street 2:M530, DANA-FARBER CANCER INSTITUTE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5418
Practice Address - Country:US
Practice Address - Phone:617-632-3465
Practice Address - Fax:617-632-5167
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA39404207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
6189024OtherMASSHEALTH MEDICAID MA
5574325OtherCIGNA
729824OtherTUFTS
B87143DFOtherHPHC DFCI ONLY
2067386OtherAETNA US HEALTHCARE
3004482OtherUNITED HEALTH CARE
50326OtherFALLON COMMUNITY HEALTH
3004482OtherUNITED HEALTH CARE
2067386OtherAETNA US HEALTHCARE
E05008Medicare ID - Type Unspecified