MEDICARE: DR. CHARLES W RICCIO MD

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	207RG0100X	Gastroenterology Physician	29185	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	110102005	OTHER	KY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000050530	OTHER	KY	BLUE CROSS AND BLUE SHIEL
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548262918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES W RICCIO MD

Provider Business Mailing Address
First Line	:	112 E MCMURTRY AVE
Second Line	:
City	:	HARTFORD
State	:	KY
Zip	:	42347-1634
Country	:	US
Telephone Number	:	270-298-7225
Fax Number	:	270-298-4084

Provider Business Practice Location Address
First Line	:	112 E MCMURTRY AVE
Second Line	:
City	:	HARTFORD
State	:	KY
Zip	:	42347-1634
Country	:	US
Telephone Number	:	270-298-7225
Fax Number	:	270-298-4084

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	05/15/2008

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