MEDICARE: JOSEPH RENZULLI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	60085	CT
2	208800000X	Urology Physician	MD11757	RI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	349005986	OTHER	RI	MEDICARE GROUP PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	33583	OTHER	RI	BLUE SHIELD
4	1659463230	OTHER	RI	GROUP NPI

General Provider Information

NPI Number	:	1538108832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH RENZULLI MD

Provider Business Mailing Address
First Line	:	PO BOX 208058
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06520-8058
Country	:	US
Telephone Number	:	203-737-7652
Fax Number	:	203-785-4043

Provider Business Practice Location Address
First Line	:	195 COLLYER ST
Second Line	:	SUITE 201
City	:	PROVIDENCE
State	:	RI
Zip	:	02904-1869
Country	:	US
Telephone Number	:	401-272-7799
Fax Number	:	401-272-9299

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	03/17/2018

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Directions to “ JOSEPH RENZULLI MD” Practice Location

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