MEDICARE: LAURA A RICCIARDI 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
1	207R00000X	Internal Medicine Physician	0101228406	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	317302	OTHER	VA	SOUTHERN HEALTH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	181906	OTHER	VA	ANTHEM BCBS

General Provider Information

NPI Number	:	1689676967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA A RICCIARDI M.D.

Provider Business Mailing Address
First Line	:	3025 BERKMAR DR
Second Line	:	SUITE 1
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22901-1456
Country	:	US
Telephone Number	:	434-973-1831
Fax Number	:	434-973-1919

Provider Business Practice Location Address
First Line	:	3025 BERKMAR DR
Second Line	:	SUITE 1
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22901-1456
Country	:	US
Telephone Number	:	434-973-1831
Fax Number	:	434-973-1919

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	11/07/2011

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Directions to “ LAURA A RICCIARDI M.D.” Practice Location

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