Provider Demographics
NPI:1558351676
Name:RIZZO, ANDREA R (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:R
Last Name:RIZZO
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:147 MILK ST
Mailing Address - Street 2:PROVIDER ENROLLMENT - 9TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-559-8374
Mailing Address - Fax:
Practice Address - Street 1:490 BOSTON POST RD
Practice Address - Street 2:SUITE 203
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-3367
Practice Address - Country:US
Practice Address - Phone:978-443-6086
Practice Address - Fax:978-287-7856
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2011-05-26
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Provider Licenses
StateLicense IDTaxonomies
MA56243207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1211382Medicaid
MA1211382Medicaid
MAJ13010Medicare PIN