Healthcare Provider Details

I. General information

NPI: 1356379242
Provider Name (Legal Business Name): JOSEPH THOMAS ZIBRIDA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 METACOM AVE
WARREN RI
02885-2348
US

IV. Provider business mailing address

639 METACOM AVE
WARREN RI
02885-2348
US

V. Phone/Fax

Practice location:
  • Phone: 401-245-1500
  • Fax: 401-247-2618
Mailing address:
  • Phone: 401-245-1500
  • Fax: 401-247-2618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD10646
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: