Provider Demographics
NPI:1467491795
Name:ARRIVIELLO, RICHARD JR (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:ARRIVIELLO
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 ECLIPSE WAY
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-6001
Mailing Address - Country:US
Mailing Address - Phone:630-650-9888
Mailing Address - Fax:
Practice Address - Street 1:3007 WESLEY CHAPEL STOUTS RD STE B
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-4008
Practice Address - Country:US
Practice Address - Phone:704-412-3612
Practice Address - Fax:704-412-3614
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036086660207P00000X
NC2010-00350207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F57959Medicare UPIN