MEDICARE: DAVID RICCIO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	022540	CT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110179063	OTHER	CT	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	010022540CT01	OTHER	CT	BLUE CROSS BLUE SHIELD
3	022540	OTHER	CT	CONNECTICARE
4	2047711	OTHER	CT	AETNA
5	NHP075	OTHER	CT	OXFORD
6	0Q2055	OTHER	CT	HEALTH NET

General Provider Information

NPI Number	:	1083613509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID RICCIO MD

Provider Business Mailing Address
First Line	:	9 WASHINGTON AVE
Second Line	:	2ND FLOOR
City	:	HAMDEN
State	:	CT
Zip	:	06518-3267
Country	:	US
Telephone Number	:	203-248-3013
Fax Number	:	203-248-2878

Provider Business Practice Location Address
First Line	:	310 MAIN ST
Second Line	:
City	:	EAST HAVEN
State	:	CT
Zip	:	06512-2919
Country	:	US
Telephone Number	:	203-467-1800
Fax Number	:	203-468-8343

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	10/17/2011

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Directions to “ DAVID RICCIO MD” Practice Location

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