Provider Demographics
NPI:1841618543
Name:RICCIUTI, ASHA (MD)
Entity Type:Individual
Prefix:
First Name:ASHA
Middle Name:
Last Name:RICCIUTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ASHA
Other - Middle Name:
Other - Last Name:BALAKRISHNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3655 VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-2539
Mailing Address - Country:US
Mailing Address - Phone:314-977-4330
Mailing Address - Fax:314-773-1167
Practice Address - Street 1:3655 VISTA AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-2539
Practice Address - Country:US
Practice Address - Phone:314-977-4330
Practice Address - Fax:314-773-1167
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMD462861207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program