Provider Demographics
NPI:1447214291
Name:RUGGIERO, DAVID MICHAEL (DPM)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:RUGGIERO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-6157
Mailing Address - Country:US
Mailing Address - Phone:401-305-3800
Mailing Address - Fax:401-305-3816
Practice Address - Street 1:1525 WAMPANOAG TRL
Practice Address - Street 2:SUITE 204
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-1038
Practice Address - Country:US
Practice Address - Phone:401-228-6710
Practice Address - Fax:401-228-6717
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDPM0299213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI05-0484592OtherTUFTS
RI05-0484592OtherUNITED HEALTHCARE
RIDR47652Medicaid
RI409956OtherBLUE CHIP
RI2642-0OtherBC BS
RI3118118OtherAETNA US HEALTHCARE
RI05-0484592OtherUNITED HEALTHCARE
RIU83642Medicare UPIN