Provider Demographics
NPI:1588685754
Name:LUCIANO SZTULMAN MD INC
Entity Type:Organization
Organization Name:LUCIANO SZTULMAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUCIANO
Authorized Official - Middle Name:
Authorized Official - Last Name:SZTULMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-521-1006
Mailing Address - Street 1:1 RANDALL SQ
Mailing Address - Street 2:SUITE 401
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-2709
Mailing Address - Country:US
Mailing Address - Phone:401-521-1006
Mailing Address - Fax:401-521-1009
Practice Address - Street 1:1 RANDALL SQ
Practice Address - Street 2:SUITE 401
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-2709
Practice Address - Country:US
Practice Address - Phone:401-521-1006
Practice Address - Fax:401-521-1009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI10209207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI709004680Medicare ID - Type Unspecified