Provider Demographics
NPI:1437131109
Name:RICCHE, DAVID ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALLEN
Last Name:RICCHE
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 1:100 VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6471
Mailing Address - Country:US
Mailing Address - Phone:865-482-1777
Mailing Address - Fax:865-482-1030
Practice Address - Street 1:100 VERMONT AVE
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6471
Practice Address - Country:US
Practice Address - Phone:865-482-1777
Practice Address - Fax:865-482-1030
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27603207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3802801Medicaid
TN080102717OtherMEDICARE RAILROAD
TN080102717OtherMEDICARE RAILROAD
TN3802801Medicare ID - Type Unspecified
TN3802801Medicare PIN