Healthcare Provider Details

I. General information

NPI: 1922004746
Provider Name (Legal Business Name): ANTHONY N RICCI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 WATERDAM PLAZA DR STE 140
MC MURRAY PA
15317-5411
US

IV. Provider business mailing address

2000 WATERDAM PLAZA DR STE 140
MC MURRAY PA
15317-5411
US

V. Phone/Fax

Practice location:
  • Phone: 724-678-0282
  • Fax: 724-260-5169
Mailing address:
  • Phone: 724-678-0282
  • Fax: 724-260-5169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License NumberMD057871L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD057871L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1638856
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: