Basic Information
| Provider Information | |||||||||
| NPI: | 1225065113 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUGGIERI | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1030 PRESIDENT AVE | ||||||||
| Address2: | SUITE 3002 | ||||||||
| City: | FALL RIVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027205923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086763411 | ||||||||
| FaxNumber: | 5086760932 | ||||||||
| Practice Location | |||||||||
| Address1: | 1030 PRESIDENT AVE | ||||||||
| Address2: | SUITE 3002 | ||||||||
| City: | FALL RIVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027205923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086763411 | ||||||||
| FaxNumber: | 5086760932 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 04/26/2010 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MA158145 | MA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0027848 | 01 | NHP | OTHER | 1700566 | 01 | UHC | OTHER | 9461208 002 | 01 | CIGNA FOR REFERRALS | OTHER | 020045787 | 01 | RAILROAD MED | OTHER | PR28496 | 05 | RI | MEDICAID | 020045787 | 01 | MA | RAILROAD MEDICARE | OTHER | 807888 | 01 | HPHC | OTHER | 000369 | 01 | SWH | OTHER | 2093283 | 01 | AETNA | OTHER | 3189392 | 05 | MA | MEDICAID | B20914802 | 01 | CIGNA | OTHER | J19613 | 01 | MASS BS | OTHER | 000000021263 | 01 | BMC | OTHER | 158145 | 01 | TUFTS | OTHER | 403436 | 01 | BLUE CHIP | OTHER | J19613 | 01 | MA | BLUE CROSS BLUE SHIELD | OTHER |