Provider Demographics
NPI:1528085289
Name:ZIZZA, VINCENT JAMES III (DO)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:JAMES
Last Name:ZIZZA
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:176 TOLL GATE ROAD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4411
Mailing Address - Country:US
Mailing Address - Phone:401-739-2984
Mailing Address - Fax:401-739-0867
Practice Address - Street 1:400 BALD HILL RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1617
Practice Address - Country:US
Practice Address - Phone:401-739-2984
Practice Address - Fax:401-739-0867
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIDO487174400000X
RIDO00487208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI10246OtherNEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND
RI794230OtherTUFTS HEALTH PLAN
RIAA38818OtherHARVARD PILGRIM HEALTH CARE
RI1805526OtherUNITED HEALTHCARE
RI8177408002OtherCIGNA
RITC72651Medicaid
RI7716215OtherAETNA
RI402643OtherBLUE CROSS & BLUE SHIELD OF RHODE ISLAND
RI2969061OtherUNITED HEALTHCARE
RIDN3002OtherRAILROAD MEDICARE
RI1805526OtherUNITED HEALTHCARE
RIG17239Medicare UPIN
RI349006065Medicare PIN