Provider Demographics
NPI:1487701975
Name:ANDREOZZI, MARK PETER (DO)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:PETER
Last Name:ANDREOZZI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3520 POST RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-7140
Mailing Address - Country:US
Mailing Address - Phone:401-921-5800
Mailing Address - Fax:401-921-5826
Practice Address - Street 1:3520 POST RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-7140
Practice Address - Country:US
Practice Address - Phone:401-921-5800
Practice Address - Fax:401-921-5826
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO00369207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1000144OtherUNITED HEALTHCARE
RI9002403Medicaid
RI000369OtherTUFTS
RI0000002640OtherBLUESHIELD OF RI
RI004693OtherBLUECHIP OF RI
RI04005983OtherRAILROAD MEDICARE
RI1945OtherNEIGHBORHOOD HEALTH PLAN
RI9002403Medicaid