Provider Demographics
NPI:1497841373
Name:HAMPTON ROADS SURGICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:HAMPTON ROADS SURGICAL ASSOCIATES PC
Other - Org Name:GIACOMO A RICCIARELLI MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GIACOMO
Authorized Official - Middle Name:A
Authorized Official - Last Name:RICCIARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-827-5700
Mailing Address - Street 1:3000 COLISEUM DRIVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666
Mailing Address - Country:US
Mailing Address - Phone:757-827-5700
Mailing Address - Fax:757-827-8349
Practice Address - Street 1:3000 COLISEUM DRIVE
Practice Address - Street 2:SUITE 203
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666
Practice Address - Country:US
Practice Address - Phone:757-827-5700
Practice Address - Fax:757-827-8349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA52244OtherSENTARA HEALTH CARE
VA440432OtherANTHEM
VA7305737Medicaid
VA440432OtherANTHEM