Healthcare Provider Details

I. General information

NPI: 1780641084
Provider Name (Legal Business Name): JOSEPH RALPH TUCCI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 MAUDE ST
PROVIDENCE RI
02908-4325
US

IV. Provider business mailing address

50 MAUDE ST
PROVIDENCE RI
02908-4325
US

V. Phone/Fax

Practice location:
  • Phone: 401-456-5716
  • Fax: 401-456-6546
Mailing address:
  • Phone: 401-456-5368
  • Fax: 401-456-5782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number04112
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: