Provider Demographics
NPI:1124062195
Name:RIZZOLI, PAUL B (MD, FAAN)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:B
Last Name:RIZZOLI
Suffix:
Gender:M
Credentials:MD, FAAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-6002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1153 CENTRE ST
Practice Address - Street 2:#4970
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-3446
Practice Address - Country:US
Practice Address - Phone:617-983-7580
Practice Address - Fax:617-983-7582
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA47901174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6187242Medicaid
MAA66337Medicare UPIN
MAJ03987Medicare ID - Type Unspecified