Individual
DR. STEPHEN PETTERUTI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
250 CENTERVILLE RD, BLDG E, WARWICK, RI 02886-2778
(401) 921-5934
(401) 921-5936
Mailing address
250 CENTERVILLE RD, BUILDING E, WARWICK, RI 02886-4400
(401) 921-5934
(401) 921-5936
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
413
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0101123
UNITED HEALTH
RI
01
—
203583
BCBS CHIP
RI
01
—
23631-3
BLUE CROSS BLUE SHIELD
RI
01
—
2654722
AETNA
RI
05
—
9003104
—
RI
Enumeration date
08/09/2005
Last updated
08/09/2012
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