Healthcare Provider Details

I. General information

NPI: 1700883055
Provider Name (Legal Business Name): RICHARD JOSEPH RUGGIERI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 06/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 WAYLAND AVE
PROVIDENCE RI
02906-4304
US

IV. Provider business mailing address

160 WAYLAND AVE
PROVIDENCE RI
02906-4304
US

V. Phone/Fax

Practice location:
  • Phone: 401-521-1221
  • Fax: 401-454-4189
Mailing address:
  • Phone: 401-521-1221
  • Fax: 401-454-4189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number07821
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: