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NPI Code Detail

MEDICARE: JENNIFER MCINNES RITZAU MD

MEDICARE: JENNIFER MCINNES RITZAU MD
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
1207QH0002XHospice and Palliative Medicine (Family Medicine) Physician272741MA
2207QG0300XGeriatric Medicine (Family Medicine) PhysicianMD11338RI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1508863432
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER MCINNES RITZAU MD
Provider Business Mailing Address
First Line : 825 CHALKSTONE AVE
Second Line :
City : PROVIDENCE
State : RI
Zip : 02908-4728
Country : US
Telephone Number : 401-621-6464
Fax Number : 401-751-3985
Provider Business Practice Location Address
First Line : 825 CHALKSTONE AVE
Second Line :
City : PROVIDENCE
State : RI
Zip : 02908-4728
Country : US
Telephone Number : 401-621-6464
Fax Number : 401-751-3985
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2005
Last Update Date : 07/31/2019

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