MEDICARE: DANIEL M RICCI M.D. P.A.

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	207R00000X	Internal Medicine Physician		NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	017CT	OTHER	NC	BCBS GROUP

General Provider Information

NPI Number	:	1689673618
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANIEL M RICCI M.D. P.A.

Provider Business Mailing Address
First Line	:	PO BOX 968
Second Line	:
City	:	WALLACE
State	:	NC
Zip	:	28466-0968
Country	:	US
Telephone Number	:	910-285-4100
Fax Number	:	910-285-4766

Provider Business Practice Location Address
First Line	:	207 E MURPHY ST
Second Line	:
City	:	WALLACE
State	:	NC
Zip	:	28466-1946
Country	:	US
Telephone Number	:	910-285-4100
Fax Number	:	910-285-4766

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DANIEL MICHAEL RICCI
Credential	:	M.D.
Telephone Number	:	910-285-4100

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	07/21/2022

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