Individual
RICHARD JOSEPH PROVENZANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
322 DEWEY ST, BENNINGTON, VT 05201-2225
(802) 447-8700
(802) 447-1500
Mailing address
322 DEWEY ST, BENNINGTON, VT 05201-2225
(802) 447-8700
(802) 447-1500
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
042-0006501
VT
207W00000X
Ophthalmology Physician
45884
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000024109
BMC
MA
01
—
000000024110
BMC
VT
05
—
0005144
—
VT
05
—
00461192
—
NY
01
—
10001651
CDPHP
MA
01
—
10001651
CDPHP
VT
05
—
110000678A
—
MA
01
—
15622
HNE
MA
01
—
15622
15622
VT
01
—
17155
MVP
MA
01
—
17155
MVP
VT
01
—
I19054
MABS
MA
01
—
I19054
MABS
VT
01
—
VT5144
VTBS
VT
Enumeration date
05/22/2006
Last updated
03/30/2018
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