Healthcare Provider Details

I. General information

NPI: 1801934682
Provider Name (Legal Business Name): GIACOMO A RICCIARELLI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 MCLAWS CIRCLE SUITE 105
WILLIAMSBURG VA
23185-5629
US

IV. Provider business mailing address

PO BOX 1239
TROY MI
48099-1239
US

V. Phone/Fax

Practice location:
  • Phone: 757-941-5600
  • Fax: 757-564-0557
Mailing address:
  • Phone: 248-824-6600
  • Fax: 855-618-6655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101029718
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101029718
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: