Provider Demographics
NPI:1235309014
Name:LERO, RITCHE MIKL V (MD)
Entity Type:Individual
Prefix:
First Name:RITCHE MIKL
Middle Name:V
Last Name:LERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2165 DORCHESTER AVE
Mailing Address - Street 2:APT. C-8
Mailing Address - City:DORCHESTER CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-5640
Mailing Address - Country:US
Mailing Address - Phone:617-296-4000
Mailing Address - Fax:
Practice Address - Street 1:CARNEY HOSPITAL
Practice Address - Street 2:2100 DORCHESTER AVENUE
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124
Practice Address - Country:US
Practice Address - Phone:617-296-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA234563207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine