Provider Demographics
NPI:1063422087
Name:BRUZZESE, ANTHONY G (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:G
Last Name:BRUZZESE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 TOLL GATE RD 109
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4458
Mailing Address - Country:US
Mailing Address - Phone:401-738-3100
Mailing Address - Fax:
Practice Address - Street 1:300 TOLL GATE RD
Practice Address - Street 2:STE 101A
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4416
Practice Address - Country:US
Practice Address - Phone:401-738-3100
Practice Address - Fax:401-738-8505
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD059932085R0202X, 2085D0003X, 2085B0100X, 2085N0700X, 2085N0904X, 2085R0204X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Neuroimaging
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI4747918OtherCIGNA
RI1198-5OtherBCBS OFFICE PROVIDER NO
RI1570-5OtherBCBS KENT PROVIDER NO
RI2203OtherNEIGHBORHOOD HLTH PLAN
RIAA42213OtherHARVARD PILGRIM HEALTH
RI005993OtherTUFTS HEALTH PLAN
RI300067258OtherRAILROAD MEDICARE
RI50356624OtherUNICARE LIFE & HEALTH INS
RI16-00137OtherUNITED HEALTHCARE
RI5055327OtherAETNA
RI7000271Medicaid
RI000361OtherBLUE CHIP
RI007000271Medicare PIN
RI5055327OtherAETNA
RI300067258OtherRAILROAD MEDICARE