Provider Demographics
NPI:1245296664
Name:RICCI, MARCO (MD)
Entity type:Individual
Prefix:
First Name:MARCO
Middle Name:
Last Name:RICCI
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 1:3333 BURNET AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-4770
Mailing Address - Fax:513-636-3847
Practice Address - Street 1:740 S LIMESTONE STE L203
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-3026
Practice Address - Country:US
Practice Address - Phone:859-323-6754
Practice Address - Fax:859-323-3499
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.149494208G00000X
IAMD-44558208G00000X
KY59058208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2671824-00Medicaid
FLH81689Medicare UPIN
FL2671824-00Medicaid