MEDICARE: MRS. DIANE R GERZEVITZ NPP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	NPP13387	RI

General Provider Information

NPI Number	:	1407810096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DIANE R GERZEVITZ NPP

Provider Business Mailing Address
First Line	:	88 FEATHERBED LN
Second Line	:
City	:	NORTH KINGSTOWN
State	:	RI
Zip	:	02852-6114
Country	:	US
Telephone Number	:	401-295-8135
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 VETERANS MEMORIAL PKWY
Second Line	:
City	:	EAST PROVIDENCE
State	:	RI
Zip	:	02914-5300
Country	:	US
Telephone Number	:	401-434-6464
Fax Number	:	401-438-1890

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	07/08/2007

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