Provider Demographics
NPI:1356379390
Name:ZIENOWICZ, RICHARD J (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:ZIENOWICZ
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 1:2 DUDLEY ST
Mailing Address - Street 2:STE 380
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-3236
Mailing Address - Country:US
Mailing Address - Phone:401-453-0120
Mailing Address - Fax:401-453-0198
Practice Address - Street 1:2 DUDLEY ST
Practice Address - Street 2:STE 380
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-3236
Practice Address - Country:US
Practice Address - Phone:401-453-0120
Practice Address - Fax:401-453-0198
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI7991208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI200967OtherBLUESHIELD
RI9020096Medicaid
RI202254OtherBLUE CHIP
RI202254OtherBLUE CHIP
RI9020096Medicaid