Provider Demographics
NPI:1689744823
Name:RICCIARDI, PHILIP E SR (CERTIFIED PODORTHIST)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:E
Last Name:RICCIARDI
Suffix:SR
Gender:M
Credentials:CERTIFIED PODORTHIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 BROWNSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15210-4202
Mailing Address - Country:US
Mailing Address - Phone:412-885-2586
Mailing Address - Fax:412-885-2597
Practice Address - Street 1:1900 BROWNSVILLE RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15210-4202
Practice Address - Country:US
Practice Address - Phone:412-885-2586
Practice Address - Fax:412-885-2597
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0738800002Medicare ID - Type UnspecifiedMEDICARE NUMBER