Provider Demographics
NPI:1235112236
Name:RICKER, DEANNA P (MD)
Entity Type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:P
Last Name:RICKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:105 CHESTNUT ST
Mailing Address - Street 2:SUITE #27
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-2599
Mailing Address - Country:US
Mailing Address - Phone:781-444-5122
Mailing Address - Fax:781-444-4106
Practice Address - Street 1:105 CHESTNUT ST
Practice Address - Street 2:SUITE #27
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2599
Practice Address - Country:US
Practice Address - Phone:781-444-5122
Practice Address - Fax:781-444-4106
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2008-06-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA41103207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA041103OtherTUFTS PROVIDER NUMBER
MA562689OtherCIGNA PROVIDER NUMBER
MA2069733Medicaid
MAB11627OtherBC/BS PROVIDER NUMBER
MA15608OtherHPHC PROVIDER NUMBER
MA4524216OtherAETNA PROVIDER #
MA183229OtherUS HEALTHCARE PROVIDER #
MA183229OtherUS HEALTHCARE PROVIDER #
MA4524216OtherAETNA PROVIDER #