Healthcare Provider Details

I. General information

NPI: 1275646440
Provider Name (Legal Business Name): ANTHONY RAYMOND RICCI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 CEDAR AVE SUITE 7
EAST GREENWICH RI
02818-3101
US

IV. Provider business mailing address

63 CEDAR AVE SUITE 7
EAST GREENWICH RI
02818-3101
US

V. Phone/Fax

Practice location:
  • Phone: 401-885-5757
  • Fax: 401-885-5796
Mailing address:
  • Phone: 401-885-5757
  • Fax: 401-885-5796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number7449
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: