Healthcare Provider Details

I. General information

NPI: 1255303533
Provider Name (Legal Business Name): PATRICK J. RICCARDI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 03/26/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 TOWNSHIP BLVD
CAMILLUS NY
13031
US

IV. Provider business mailing address

251 SALINA MEADOWS PKWY SUITE 100
SYRACUSE NY
13212
US

V. Phone/Fax

Practice location:
  • Phone: 315-551-6000
  • Fax: 315-434-5300
Mailing address:
  • Phone: 315-464-2014
  • Fax: 315-464-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number1449651
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: