Basic Information
| Provider Information | |||||||||
| NPI: | 1245283316 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RIZZO | ||||||||
| FirstName: | ALBERT | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 4745 OGLETOWN STANTON RD | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197132067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3023685515 | ||||||||
| FaxNumber: | 3023661240 | ||||||||
| Practice Location | |||||||||
| Address1: | 4745 OGLETOWN STANTON RD | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197132067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3023685515 | ||||||||
| FaxNumber: | 3023661240 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 11/29/2016 | ||||||||
| 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 | 207RP1001X | C10002286 | DE | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 441729 | 01 | INDEPENDENCE BCBS | OTHER | 4284636 | 01 | AETNA/USHC | OTHER | 1167271001 | 01 | CIGNA | OTHER | 44368 | 01 | COVENTRY | OTHER | 290751 | 01 | MAMSI | OTHER | 0000058501 | 05 | DE | MEDICAID | 0101225000 | 01 | AMERIHEALTH/KEYSTONE | OTHER | 52686002 | 01 | MD | CAREFIRST BCBS | OTHER |