Provider Demographics
NPI:1326010695
Name:RICCI, MICHAEL ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:RICCI
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:CENTRAL MAINE CARDIOVASCULAR SURGERY
Mailing Address - Street 2:60 HIGH STREET
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240
Mailing Address - Country:US
Mailing Address - Phone:207-795-8260
Mailing Address - Fax:207-795-8280
Practice Address - Street 1:CENTRAL MAINE CARDIOVASCULAR SURGERY
Practice Address - Street 2:60 HIGH STREET
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240
Practice Address - Country:US
Practice Address - Phone:207-795-8260
Practice Address - Fax:207-795-8280
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD192462086S0102X, 2086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEVT922304Medicare UPIN
MEVT922303Medicare UPIN
MEVT922305Medicare UPIN
MEVT922302Medicare UPIN