Healthcare Provider Details

I. General information

NPI: 1154311314
Provider Name (Legal Business Name): MARTHA A PIZZARELLO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARTHA A DEPETERS MD

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

297 PROMENADE ST
PROVIDENCE RI
02908-5720
US

IV. Provider business mailing address

297 PROMENADE ST
PROVIDENCE RI
02908-5720
US

V. Phone/Fax

Practice location:
  • Phone: 401-490-6464
  • Fax:
Mailing address:
  • Phone: 401-490-6464
  • Fax: 617-726-2894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD12397
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: