Healthcare Provider Details

I. General information

NPI: 1336436229
Provider Name (Legal Business Name): MICHAEL RICARDO D.O., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 ROUTE 73
VOORHEES NJ
08043-9653
US

IV. Provider business mailing address

401 ROUTE 73 N STE 320
MARLTON NJ
08053-3426
US

V. Phone/Fax

Practice location:
  • Phone: 856-218-0300
  • Fax: 856-589-9487
Mailing address:
  • Phone: 856-772-2300
  • Fax: 856-589-9487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MB10440700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: