Healthcare Provider Details

I. General information

NPI: 1760010805
Provider Name (Legal Business Name): MICHAEL BRETT RICCI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 OGLETOWN STANTON RD STE 2200
NEWARK DE
19713-7000
US

IV. Provider business mailing address

4701 OGLETOWN STANTON RD STE 2200
NEWARK DE
19713-7000
US

V. Phone/Fax

Practice location:
  • Phone: 302-623-4960
  • Fax: 302-623-4965
Mailing address:
  • Phone: 302-623-4960
  • Fax: 302-623-4965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC1-0027194
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberC1-0027194
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: