Provider Demographics
NPI:1396773644
Name:RUGGIERO, MARK LOUIS (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:LOUIS
Last Name:RUGGIERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:455 CHASE PKWY
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3352
Mailing Address - Country:US
Mailing Address - Phone:203-573-1435
Mailing Address - Fax:203-755-7433
Practice Address - Street 1:455 CHASE PKWY
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3352
Practice Address - Country:US
Practice Address - Phone:203-573-1435
Practice Address - Fax:203-755-7433
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT033880207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060062866OtherRAILROAD MEDICARE
CT206672OtherWELLCARE
CT25-40444OtherUNITED HEALTHCARE
CT033880OtherCONNECTICARE
CT12-53847OtherUHC
CT2975035/5284461OtherAETNA
CT5284461OtherAETNA HEALTH PLANS
CTP00024935OtherRR MEDICARE
CT12-53847OtherAMERICHOICE
CT1396773644Medicaid
CT033880-H429OtherCONNECTICARE
CT2V2902OtherHEALTHNET/COMMERCIAL
CT874325OtherUSA
CT001338806Medicaid
CT010033880CT06OtherANTHEM BCBS CT
CT0V8017OtherHEALTH NET OF NORTHEAST
CTNHS225OtherOXFORD HEALTH PLANS
CT010033880CT05OtherANTHEM BC & BS
CT01033880OtherCIGNA HEALTH PLANS
CTP2743333OtherOXFORD
CT0V8017OtherHEALTH NET OF NORTHEAST
CT010033880CT06OtherANTHEM BCBS CT
CT060062866OtherRAILROAD MEDICARE