Healthcare Provider Details

I. General information

NPI: 1508863432
Provider Name (Legal Business Name): JENNIFER MCINNES RITZAU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER BLOIS MCINNES

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 CHALKSTONE AVE
PROVIDENCE RI
02908-4728
US

IV. Provider business mailing address

825 CHALKSTONE AVE
PROVIDENCE RI
02908-4728
US

V. Phone/Fax

Practice location:
  • Phone: 401-621-6464
  • Fax: 401-751-3985
Mailing address:
  • Phone: 401-621-6464
  • Fax: 401-751-3985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number272741
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberMD11338
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: