Provider Demographics
NPI:1497725709
Name:RICCARDO, JOHN N (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:N
Last Name:RICCARDO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:797 E LANCASTER AVE
Mailing Address - Street 2:STE 17
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-3315
Mailing Address - Country:US
Mailing Address - Phone:610-269-8155
Mailing Address - Fax:610-269-9557
Practice Address - Street 1:797 E LANCASTER AVE
Practice Address - Street 2:STE 17
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-3315
Practice Address - Country:US
Practice Address - Phone:610-269-8155
Practice Address - Fax:610-269-9557
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS012424207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I18081Medicare UPIN
PA084026Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER #