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NPI Code Detail

MEDICARE: MATTHEW PAUL RICCARDI

MEDICARE: MATTHEW PAUL RICCARDI
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 Assistant14244652-1206UT

General Provider Information

NPI Number : 1841993805
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW PAUL RICCARDI
Provider Business Mailing Address
First Line : 1760 E RAMONA AVE
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84108-3110
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1760 E RAMONA AVE
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84108-3110
Country : US
Telephone Number : 727-729-0892
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2023
Last Update Date : 03/10/2026

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Directions to “ MATTHEW PAUL RICCARDI ” Practice Location

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