Provenzano, Richard Joseph

Provenzano, Richard Joseph is an individual health care provider with primary practice located at 322 Dewey St , Bennington VT 05201-2225. He recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as his primary health care specialty. Provenzano, Richard Joseph can be contacted via phone (802) 447-8700.

Contact Information

Primary practice address
322 Dewey St Bennington VT 05201-2225
Phone: (802) 447-8700
Fax: (802) 447-1500
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X 45884 Massachusetts
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X 042-0006501 Vermont

Profile Details

NPI number 1962456905
LBN Legal business name Provenzano, Richard Joseph
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 22nd, 2006
Last updated Mar 30th, 2018 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1962456905 NPPES
Vermont Other I19054 MABS
Vermont MEDICAID 00461192 MABS
Vermont Other VT5144 MABS
Vermont Other 000000024109 MABS
Vermont Other 10001651 MABS
Vermont Other 15622 MABS
Vermont Other 15622 MABS
Vermont Other 17155 MABS
Vermont Other 000000024110 MABS
Vermont MEDICAID 110000678A MABS
Vermont Other 10001651 MABS
Vermont Other I19054 MABS
Vermont MEDICAID 0005144 MABS
Vermont Other 17155 MABS

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