Healthcare Provider Details

I. General information

NPI: 1417943291
Provider Name (Legal Business Name): KENNETH ROCEO CATALLOZZI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 08/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2138 MENDON RD
CUMBERLAND RI
02864
US

IV. Provider business mailing address

725 RESERVOIR AVE
CRANSTON RI
02910-4450
US

V. Phone/Fax

Practice location:
  • Phone: 401-944-3800
  • Fax: 401-943-3129
Mailing address:
  • Phone: 401-944-3800
  • Fax: 401-943-3129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD06517
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: