Provider Demographics
NPI:1417943291
Name:CATALLOZZI, KENNETH ROCEO (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:ROCEO
Last Name:CATALLOZZI
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 1:725 RESERVOIR AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-4450
Mailing Address - Country:US
Mailing Address - Phone:401-944-3800
Mailing Address - Fax:401-943-3129
Practice Address - Street 1:2138 MENDON RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864
Practice Address - Country:US
Practice Address - Phone:401-944-3800
Practice Address - Fax:401-943-3129
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD06517207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIKC26497Medicaid
RI201865OtherBLUE CHIP
RI321675OtherBLUE CROSS
RI1417943291OtherDURABLE
RI2090200571Medicare PIN
D94229Medicare UPIN