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Individual

ROGER T PEZZUTI

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
22 BRAMHALL ST, PORTLAND, ME 04102-3134
(207) 662-2571
Mailing address
324 GANNETT DR STE 200, SOUTH PORTLAND, ME 04106-3266

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
007895
ME
2085R0204X
Vascular & Interventional Radiology Physician
007895
ME

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
01Y000185NH01
ANTHEM
NH
01
026375
ANTHEM
ME
01
1040947
AETNA USHC
ME
05
30007026
NH
05
305170099
ME
01
5023092
AETNA
ME
01
B86369
HPHC
ME
01
M52973
CIGNA
ME
Enumeration date
11/15/2006
Last updated
07/23/2009
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