1386662138 NPI number — THOMAS RIZZO JR. M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386662138 NPI number — THOMAS RIZZO JR. M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

RIZZO

Provider First Name:

THOMAS

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

JR.

Provider Credential Text:

M.D.

Provider Gender Code:

M

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:

1386662138

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/10/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 8500-6335

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

PHILADELPHIA

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

19178-0001

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

215-807-8000

Provider Business Mailing Address Fax Number:

215-807-8235

Provider First Line Business Practice Location Address:

3998 RED LION RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

PHILADELPHIA

Provider Business Practice Location Address State Name:

PA

Provider Business Practice Location Address Postal Code:

19114-1436

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

215-612-4000

Provider Business Practice Location Address Fax Number:

215-807-8235

Provider Enumeration Date:

07/18/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207ZP0102X , with the licence number:  MD011964L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0059918000 . This is a "KEYSTONE IBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: PA0032668 . This is a "TRICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 28898 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 0015543260001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 0015543260002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 141426 . This is a "PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 0015543260007 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 01554326-01 . This is a "AMERICHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 141426 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 2968422 . This is a "AETNA CONTRACT" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 34008C . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 6982997 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".