MEDICARE: DR. GINO JOSEPH VRICELLA 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	2088P0231X	Pediatric Urology Physician	2013017657	MO
2	208800000X	Urology Physician	2013017657	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548464431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GINO JOSEPH VRICELLA MD

Provider Business Mailing Address
First Line	:	660 S EUCLID AVE
Second Line	:	MSC 8242-22-02
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1010
Country	:	US
Telephone Number	:	314-362-8200
Fax Number	:	314-367-5016

Provider Business Practice Location Address
First Line	:	1 CHILDRENS PL
Second Line	:	DIV SURG UROLOGY PED, STE 2A
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1002
Country	:	US
Telephone Number	:	314-454-6034
Fax Number	:	314-454-2876

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

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	11/15/2021

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