Healthcare Provider Details

I. General information

NPI: 1073237103
Provider Name (Legal Business Name): MICHAEL ANGELO RICCA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MICHAEL WILLIAM LINTZ

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 NATIONAL DR STE 100
BURTONSVILLE MD
20866-1176
US

IV. Provider business mailing address

2809 BOSTON ST APT 338
BALTIMORE MD
21224-4849
US

V. Phone/Fax

Practice location:
  • Phone: 301-421-1125
  • Fax: 301-500-2175
Mailing address:
  • Phone: 410-236-6691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: