1174528699 NPI number — DR. VINCENT A CATALLOZZI M.D.

Table of content: DR. VINCENT A CATALLOZZI M.D. (NPI 1174528699)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174528699 NPI number — DR. VINCENT A CATALLOZZI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CATALLOZZI
Provider First Name:
VINCENT
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174528699
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2234 COLONIAL BLVD
Provider Second Line Business Mailing Address:
ATTN: PAYER CONTRACTING & RELATIONS
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33907-1412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-931-7342
Provider Business Mailing Address Fax Number:
239-931-7385

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
207 QUAKER LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST WARWICK
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02893-2283
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-828-7110
Provider Business Practice Location Address Fax Number:
401-827-6364
Provider Enumeration Date:
06/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MD06163 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X , with the licence number: MD06163 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AA336910 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 1074839 . This is a "COVENTRY" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 7005300 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4556831 . This is a "AETNA" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 4767305 . This is a "CIGNA" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: P01277532 . This is a "RAILROAD MCR" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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