Individual
JOHN ALBERT PEZZULLO III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
125 METRO CENTER BLVD STE 2000, WARWICK, RI 02886-1785
(401) 432-2520
(401) 453-8220
Mailing address
125 METRO CENTER BLVD STE 2000, WARWICK, RI 02886-1785
(401) 432-2520
(401) 453-8220
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
10244
RI
2085R0202X
Diagnostic Radiology Physician
212505
MA
2085R0202X
Diagnostic Radiology Physician
Primary
MD10244
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000000001988
NHPRI
—
01
—
003117117
CT MED ASSISTANCE
—
01
—
007008119
MEDICARE
—
01
—
007008121
HOSPITAL PIN
—
01
—
010244
TUFTS
—
01
—
1600094
UNITEDHEALTHPLANS
—
01
—
241272
RIHPILGRIM
—
01
—
300108647
RAILROADMEDICARE
—
01
—
3208486
MASSMEDICAID
—
01
—
407649
BLUECHIP
—
01
—
7008119
RIMEDICALASSISTANCE
—
01
—
720099401
CIGNA
—
01
—
9102814
PHHCS
—
Enumeration date
10/13/2005
Last updated
03/19/2019
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