Basic Information
| Provider Information | |||||||||
| NPI: | 1447203393 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUGGIERI | ||||||||
| FirstName: | EWA | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 45 WELLS ST | ||||||||
| Address2: | STE 201 | ||||||||
| City: | WESTERLY | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028912927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4016377200 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 147 WESTBROOK RD | ||||||||
| Address2: | |||||||||
| City: | ESSEX | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064261512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607678265 | ||||||||
| FaxNumber: | 8603588653 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 10/22/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD16857 | RI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 214806 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 008063529 | 05 | CT | MEDICAID | 01987939 | 05 | NY | MEDICAID |