Healthcare Provider Details

I. General information

NPI: 1497725709
Provider Name (Legal Business Name): JOHN N RICCARDO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 E LANCASTER AVE
DOWNINGTOWN PA
19335-2941
US

IV. Provider business mailing address

363 E LANCASTER AVE
DOWNINGTOWN PA
19335-2941
US

V. Phone/Fax

Practice location:
  • Phone: 610-910-9888
  • Fax: 484-237-8743
Mailing address:
  • Phone: 610-910-9888
  • Fax: 484-237-8743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS012424
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: