RICCI, PETER EDWARD JR (MD)

Provider Demographics

• NPI: 1679524904
• Name: RICCI, PETER EDWARD JR (MD)
• Entity Type: Individual
• Prefix: DR
• First Name: PETER
• Middle Name: EDWARD
• Last Name: RICCI
• Suffix: JR
• Gender: M
• Credentials: MD
• Mailing Address - Street 1: 10800 E GEDDES AVE STE 300
• Mailing Address - City: ENGLEWOOD
• Mailing Address - State: CO
• Mailing Address - Zip Code: 80112-3895
• Mailing Address - Country: US
• Mailing Address - Phone: 303-761-9190
• Mailing Address - Fax: 720-874-4462
• Practice Address - Street 1: 501 E HAMPDEN AVE
• Practice Address - City: ENGLEWOOD
• Practice Address - State: CO
• Practice Address - Zip Code: 80113-2702
• Practice Address - Country: US
• Practice Address - Phone: 303-761-9190
• Practice Address - Fax: 720-874-4462
• Is Sole Proprietor?: No
• Enumeration Date: 2006-05-12
• Last Update Date: 2024-03-31

Provider Licenses

State	License ID	Taxonomies
HI	17633	2085R0202X
KS	04-34796	2085R0202X
NE	25241	2085R0202X
TN	29742	2085R0202X
CO	37631	2085R0202X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	2085R0202X	Allopathic & Osteopathic Physicians	Radiology	Diagnostic Radiology

Provider Identifiers

State	Identifier ID	ID Type	Issuer
CO	300105816	Other	RAILROAD MEDICARE RIA
CO	300105817	Other	RAILROAD MEDICARE MIC
NY	02300278	Medicaid
ID	1679524904	Medicaid
SD	1679524904/7729320	Medicaid
CO	52953343	Medicaid
NE	84-059792913	Medicaid
NE	CO305959	Other	MEDICARE TRAILBLAZER RIN
NE	10025709000	Medicaid
AK	MD002CO	Medicaid
WY	1679524904	Medicaid
AZ	663883	Medicaid
NE	NA1215054	Other	RIN WPS MCR NA1215
NM	21183023	Medicaid
UT	1679513196	Medicaid
CT	1679524909	Medicaid
KS	200424910A	Medicaid
NE	NA1214054	Other	RIN MCR WPS NA1214
HI	0000343822	Other	HMSA ALL PRODUCTS
MI	104686329	Medicaid
MT	1679524904	Medicaid
KS	KA3249030	Medicare PIN
CO	392519ZLJ3	Medicare PIN
NE	NA1214054	Other	RIN MCR WPS NA1214
CO	300105816	Other	RAILROAD MEDICARE RIA
UT	1679513196	Medicaid
ID	1679524904	Medicaid
HI	0000343822	Other	HMSA ALL PRODUCTS
CO	G34648	Medicare UPIN
NY	02300278	Medicaid
CO	C211658	Medicare PIN
AK	MD002CO	Medicaid
HI	H105420	Medicare PIN