Healthcare Provider Details

I. General information

NPI: 1669827218
Provider Name (Legal Business Name): CHARLES ALEXANDER RICCIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 N FEDERAL HWY STE 101C
BOCA RATON FL
33431-3427
US

IV. Provider business mailing address

4800 N FEDERAL HWY STE 101C
BOCA RATON FL
33431-3427
US

V. Phone/Fax

Practice location:
  • Phone: 561-367-9101
  • Fax:
Mailing address:
  • Phone: 561-367-9101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberME163152
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: