Provider Demographics
NPI:1013952498
Name:PATRIZIO, GINA L (MSPT)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:L
Last Name:PATRIZIO
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 HOPE FURNACE RD
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:RI
Mailing Address - Zip Code:02831-1447
Mailing Address - Country:US
Mailing Address - Phone:401-823-4100
Mailing Address - Fax:401-823-4111
Practice Address - Street 1:6 HOPE FURNACE RD
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:RI
Practice Address - Zip Code:02831-1447
Practice Address - Country:US
Practice Address - Phone:401-823-4100
Practice Address - Fax:401-823-4111
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI1097174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI24870-9OtherBLUE CROSS/BLUE SHIELD
RI659024870Medicare ID - Type Unspecified