Provider Demographics
NPI:1992182208
Name:RIDZON, RENEE (MD)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:RIDZON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 WORCESTER ST
Mailing Address - Street 2:#3
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-3906
Mailing Address - Country:US
Mailing Address - Phone:857-753-4568
Mailing Address - Fax:
Practice Address - Street 1:41 WORCESTER ST
Practice Address - Street 2:#3
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-3906
Practice Address - Country:US
Practice Address - Phone:857-753-4568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040984207RI0200X
MOR2H71207R00000X
MA1092909207R00000X
RIMD7776207RI0200X
WAMD00042458207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine