MEDICARE: DANIEL A RISCO

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	207PS0010X	Sports Medicine (Emergency Medicine) Physician	0019007222	VA

General Provider Information

NPI Number	:	1538825278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL A RISCO

Provider Business Mailing Address
First Line	:	7524 RICHMOND HWY
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-2351
Country	:	US
Telephone Number	:	571-310-6269
Fax Number	:

Provider Business Practice Location Address
First Line	:	7524 RICHMOND HWY
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-2351
Country	:	US
Telephone Number	:	571-310-6269
Fax Number	:

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

Provider Enumeration Date	:	11/16/2021
Last Update Date	:	11/16/2021

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Directions to “ DANIEL A RISCO ” Practice Location

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