MEDICARE: MICHAEL ANGELO RICCA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1073237103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL ANGELO RICCA

Provider Business Mailing Address
First Line	:	2809 BOSTON ST APT 338
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21224-4849
Country	:	US
Telephone Number	:	410-236-6691
Fax Number	:

Provider Business Practice Location Address
First Line	:	3901 NATIONAL DR STE 100
Second Line	:
City	:	BURTONSVILLE
State	:	MD
Zip	:	20866-1176
Country	:	US
Telephone Number	:	301-421-1125
Fax Number	:	301-500-2175

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2022
Last Update Date	:	07/07/2023

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Directions to “ MICHAEL ANGELO RICCA ” Practice Location

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