Provider Demographics
NPI:1255303533
Name:RICCARDI, PATRICK J (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:J
Last Name:RICCARDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5794 WIDEWATERS PKWY
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13214-1845
Mailing Address - Country:US
Mailing Address - Phone:315-422-1513
Mailing Address - Fax:315-422-5890
Practice Address - Street 1:5794 WIDEWATERS PKWY
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13214-1845
Practice Address - Country:US
Practice Address - Phone:315-422-1513
Practice Address - Fax:315-422-5890
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2017-06-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1449651207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00622468Medicaid
NY00622468Medicaid
NYB81993Medicare UPIN
NY00622468Medicaid