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NPI Code Detail

MEDICARE: ANDIE LARICCIA

MEDICARE: ANDIE LARICCIA
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
1363A00000XPhysician Assistant50.010007RXOH

General Provider Information

NPI Number : 1326911694
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDIE LARICCIA
Provider Business Mailing Address
First Line : 3131 NEWMARK DR STE 220
Second Line :
City : MIAMISBURG
State : OH
Zip : 45342-5400
Country : US
Telephone Number : 937-438-8910
Fax Number :
Provider Business Practice Location Address
First Line : 3535 SOUTHERN BLVD
Second Line :
City : KETTERING
State : OH
Zip : 45429-1221
Country : US
Telephone Number : 937-395-8166
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/24/2025
Last Update Date : 02/03/2026

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Directions to “ ANDIE LARICCIA ” Practice Location

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