Provider Demographics
NPI:1154403566
Name:IZZI, GERALD (MD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:
Last Name:IZZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:125 PARKER HILL AVE
Mailing Address - Street 2:STE 500
Mailing Address - City:ROXBURY CROSSING
Mailing Address - State:MA
Mailing Address - Zip Code:02120-2847
Mailing Address - Country:US
Mailing Address - Phone:617-735-9200
Mailing Address - Fax:617-735-9230
Practice Address - Street 1:125 PARKER HILL AVE
Practice Address - Street 2:STE 500
Practice Address - City:ROXBURY CROSSING
Practice Address - State:MA
Practice Address - Zip Code:02120-2847
Practice Address - Country:US
Practice Address - Phone:617-735-9200
Practice Address - Fax:617-735-9230
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA55246207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ08436OtherBXBS
MA712365OtherTUFTS
RI226211OtherBX OF RI
MA2500376OtherUNITED HLTHCARE
MA61468OtherHARVARD PILGRIM
MA3131165Medicaid
MA2500376OtherUNITED HLTHCARE
MA61468OtherHARVARD PILGRIM