Provider Demographics
NPI:1710950142
Name:RIZZUTO, PHILIP R (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:R
Last Name:RIZZUTO
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 1:120 DUDLY ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905
Mailing Address - Country:US
Mailing Address - Phone:401-274-6622
Mailing Address - Fax:
Practice Address - Street 1:120 DUDLY ST
Practice Address - Street 2:SUITE 301
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905
Practice Address - Country:US
Practice Address - Phone:401-274-6622
Practice Address - Fax:401-490-7051
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD08913207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9025630Medicaid
RI25630OtherBLUE SHIELD
3190323OtherWELFARE
RI401138OtherBLUECROSS
RI9025630Medicaid