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Individual

JOSEPH RENZULLI

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
195 COLLYER ST, SUITE 201, PROVIDENCE, RI 02904-1869
(401) 272-7799
(401) 272-9299
Mailing address
PO BOX 208058, NEW HAVEN, CT 06520-8058
(203) 737-7652
(203) 785-4043

Taxonomy

Speciality
Code
Description
License number
State
208800000X
Urology Physician
60085
CT
208800000X
Urology Physician
Primary
MD11757
RI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1659463230
GROUP NPI
RI
01
33583
BLUE SHIELD
RI
01
349005986
MEDICARE GROUP PTAN
RI
05
9004842
RI
Enumeration date
06/05/2006
Last updated
03/17/2018
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