Healthcare Provider Details

I. General information

NPI: 1689744823
Provider Name (Legal Business Name): PHILIP E. RICCIARDI SR. CERTIFIED PODORTHIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 BROWNSVILLE RD
PITTSBURGH PA
15210-4202
US

IV. Provider business mailing address

1900 BROWNSVILLE RD
PITTSBURGH PA
15210-4202
US

V. Phone/Fax

Practice location:
  • Phone: 412-885-2586
  • Fax: 412-885-2597
Mailing address:
  • Phone: 412-885-2586
  • Fax: 412-885-2597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: