Provider Demographics
NPI:1588017016
Name:RINZIVILLO, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:RINZIVILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6637 STATE ROUTE 30
Mailing Address - Street 2:
Mailing Address - City:JEANNETTE
Mailing Address - State:PA
Mailing Address - Zip Code:15644-3171
Mailing Address - Country:US
Mailing Address - Phone:845-217-2480
Mailing Address - Fax:
Practice Address - Street 1:6637 STATE ROUTE 30
Practice Address - Street 2:
Practice Address - City:JEANNETTE
Practice Address - State:PA
Practice Address - Zip Code:15644-3171
Practice Address - Country:US
Practice Address - Phone:845-217-2480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA473481959207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease