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NPI Code Detail

MEDICARE: DR. JOHN A RICCIO M.D.

MEDICARE: DR. JOHN A RICCIO M.D.
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
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician195382NY

General Provider Information

NPI Number : 1518959469
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN A RICCIO M.D.
Provider Business Mailing Address
First Line : 4567 CROSSROADS PARK DR
Second Line : 2ND FL
City : LIVERPOOL
State : NY
Zip : 13088-3589
Country : US
Telephone Number : 315-295-2100
Fax Number : 315-295-2125
Provider Business Practice Location Address
First Line : 17 LANSING ST
Second Line :
City : AUBURN
State : NY
Zip : 13021-1983
Country : US
Telephone Number : 315-255-7027
Fax Number : 315-255-7087
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2005
Last Update Date : 09/13/2007

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