Provider Demographics
NPI:1669492070
Name:SZTULMAN, LUCIANO (MD)
Entity Type:Individual
Prefix:
First Name:LUCIANO
Middle Name:
Last Name:SZTULMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI10209207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9021290Medicaid
RI9021290Medicaid
RI007058350Medicare ID - Type Unspecified