Provider Demographics
NPI:1558480434
Name:RICHARD J. RUGGIERI, MD, INC.
Entity Type:Organization
Organization Name:RICHARD J. RUGGIERI, MD, INC.
Other - Org Name:WAYLAND MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUGGIERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-521-1221
Mailing Address - Street 1:160 WAYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-4304
Mailing Address - Country:US
Mailing Address - Phone:401-521-1221
Mailing Address - Fax:401-454-4189
Practice Address - Street 1:160 WAYLAND AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4304
Practice Address - Country:US
Practice Address - Phone:401-521-1221
Practice Address - Fax:401-454-4189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI07821207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9021123Medicaid
DD2464OtherRAILROAD MEDICARE GROUP #
MA404203OtherTUFTS GROUP #
MA404203OtherTUFTS GROUP #