Provider Demographics
NPI:1134170954
Name:RICCA, CHRISTOPHER EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:EDWARD
Last Name:RICCA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 E 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-3802
Mailing Address - Country:US
Mailing Address - Phone:303-329-6500
Mailing Address - Fax:303-329-9020
Practice Address - Street 1:4525 E 8TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3802
Practice Address - Country:US
Practice Address - Phone:303-329-6500
Practice Address - Fax:303-329-9020
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO37299207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO72632763Medicaid
CO72632763Medicaid
COG97681Medicare UPIN