Provider Demographics
NPI:1932198082
Name:RIZACK, TINA (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:
Last Name:RIZACK
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 229
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02880-0229
Mailing Address - Country:US
Mailing Address - Phone:401-788-3337
Mailing Address - Fax:401-783-1872
Practice Address - Street 1:85 KENYON AVE
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-4213
Practice Address - Country:US
Practice Address - Phone:401-783-6670
Practice Address - Fax:401-789-4990
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA217542207R00000X
RIMD10782207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H55245Medicare UPIN
MAA35190Medicare ID - Type Unspecified