Provider Demographics
NPI:1437153830
Name:RICCIARDI, SANTUCCIO (MD)
Entity Type:Individual
Prefix:
First Name:SANTUCCIO
Middle Name:
Last Name: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 1:7067 TIFFANY BLVD
Mailing Address - Street 2:STE 250
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44514-1981
Mailing Address - Country:US
Mailing Address - Phone:330-726-4500
Mailing Address - Fax:330-726-5931
Practice Address - Street 1:7067 TIFFANY BLVD
Practice Address - Street 2:STE 250
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44514-1981
Practice Address - Country:US
Practice Address - Phone:330-726-4500
Practice Address - Fax:330-726-5931
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-9111207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0827403Medicaid
OHE87016Medicare UPIN
OH0827403Medicaid