Provider Demographics
NPI:1649577370
Name:DEANNA P. RICKER, M.D., P.C.
Entity Type:Organization
Organization Name:DEANNA P. RICKER, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:P
Authorized Official - Last Name:RICKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-444-5122
Mailing Address - Street 1:105 CHESTNUT ST
Mailing Address - Street 2:SUITE #27
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-2599
Mailing Address - Country:US
Mailing Address - Phone:781-444-5122
Mailing Address - Fax:781-444-4106
Practice Address - Street 1:105 CHESTNUT ST
Practice Address - Street 2:SUITE #27
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2599
Practice Address - Country:US
Practice Address - Phone:781-444-5122
Practice Address - Fax:781-444-4106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-15
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA41103207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2069733Medicaid
MA2069733Medicaid