Provider Demographics
NPI:1952304883
Name:RIZZUTI, RICHARD PHILLIP (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:PHILLIP
Last Name:RIZZUTI
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 1:707 JORDAN DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-9175
Mailing Address - Country:US
Mailing Address - Phone:252-756-4194
Mailing Address - Fax:252-830-5138
Practice Address - Street 1:400 SPRING FOREST RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7244
Practice Address - Country:US
Practice Address - Phone:252-758-6627
Practice Address - Fax:252-830-5138
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28797174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC71899OtherBCBS
NC8971899Medicaid
NCE06696Medicare UPIN
NC71899OtherBCBS