Provider Demographics
NPI:1407422801
Name:FERNANDES RICCIARDI, JEAN PAULO (MD)
Entity Type:Individual
Prefix:MR
First Name:JEAN
Middle Name:PAULO
Last Name:FERNANDES RICCIARDI
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 1:1215 LEE STREET
Mailing Address - Street 2:MAILSTOP 800699
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22908
Mailing Address - Country:US
Mailing Address - Phone:434-924-8485
Mailing Address - Fax:434-924-2231
Practice Address - Street 1:1215 LEE STREET
Practice Address - Street 2:MAILSTOP 800699
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908
Practice Address - Country:US
Practice Address - Phone:434-924-8485
Practice Address - Fax:434-924-2231
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2023-06-22
Deactivation Date:2023-03-27
Deactivation Code:
Reactivation Date:2023-06-22
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program