Healthcare Provider Details

I. General information

NPI: 1447214291
Provider Name (Legal Business Name): DAVID MICHAEL RUGGIERO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 11/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 WAMPANOAG TRL SUITE 204
RIVERSIDE RI
02915-1038
US

IV. Provider business mailing address

649 EAST AVE
PAWTUCKET RI
02860-6157
US

V. Phone/Fax

Practice location:
  • Phone: 401-228-6710
  • Fax: 401-228-6717
Mailing address:
  • Phone: 401-305-3800
  • Fax: 401-305-3816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberDPM0299
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: