Provider Demographics
NPI:1629087242
Name:RICCIARDI, ANTHONY M (DPM)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:M
Last Name:RICCIARDI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7135 W SAHARA AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2873
Mailing Address - Country:US
Mailing Address - Phone:702-878-2455
Mailing Address - Fax:702-878-4875
Practice Address - Street 1:7135 W SAHARA AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2873
Practice Address - Country:US
Practice Address - Phone:702-878-2455
Practice Address - Fax:702-878-4875
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9507213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV480022781OtherRAILROAD MEDICARE
NV480022781OtherRAILROAD MEDICARE
NVU56919Medicare UPIN
NVV100675Medicare PIN