Provider Demographics
NPI:1013945344
Name:LANZILLO, CHARLES FRANCIS JR
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:FRANCIS
Last Name:LANZILLO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CHARLES
Other - Middle Name:F
Other - Last Name:LANZILLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:17 WELLS ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-2923
Mailing Address - Country:US
Mailing Address - Phone:401-596-0339
Mailing Address - Fax:401-596-3437
Practice Address - Street 1:17 WELLS ST
Practice Address - Street 2:SUITE 102
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-2923
Practice Address - Country:US
Practice Address - Phone:401-596-0339
Practice Address - Fax:401-596-3437
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI6503207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI003611OtherBLUE CHIP
CT010025951CT01OtherBLUE SHIELD OF CT
180000279OtherDMERC
031463OtherHEALTHNET
000000002011OtherNEIGHBORHOOD HEALTH PLAN
CT001259514Medicaid
0800140OtherUNITED HEALTH CARE
180000279OtherRAILROAD MEDICARE
NLS024OtherOXFORD
RI0000002064OtherBLUE SHIELD OF RI
AA33959OtherHARVARD PILGRIM HEALTH
031463OtherHEALTHNET
CT180000279Medicare ID - Type Unspecified
CT001259514Medicaid