Healthcare Provider Details

I. General information

NPI: 1871721456
Provider Name (Legal Business Name): RICCA AIMEE ANDO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 06/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4623 SPRUCE STREET
PHILADELPHIA PA
19139-4542
US

IV. Provider business mailing address

4623 SPRUCE STREET
PHILADELPHIA PA
19139-4542
US

V. Phone/Fax

Practice location:
  • Phone: 215-474-6100
  • Fax:
Mailing address:
  • Phone: 215-474-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOT012823
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS015497
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: