=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790734119
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSEPH J RIZZO MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2006
-----------------------------------------------------
Last Update Date | 10/07/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1040 DELAWARE AVENUE
-----------------------------------------------------
City | MARION
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43301-1814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-383-8080
-----------------------------------------------------
Fax | 740-383-8084
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | L-3549
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43260-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-383-7927
-----------------------------------------------------
Fax | 740-383-7942
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 35050590
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number | 35.050590
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------