Provider Demographics
NPI:1740472646
Name:RIDELLA, MARICEL LILIAN (MD)
Entity type:Individual
Prefix:DR
First Name:MARICEL
Middle Name:LILIAN
Last Name:RIDELLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:860 OMNI BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NEWPORT
Mailing Address - State:VA
Mailing Address - Zip Code:23662-1027
Mailing Address - Country:US
Mailing Address - Phone:757-232-8769
Mailing Address - Fax:757-232-8875
Practice Address - Street 1:704 THIMBLE SHOALS BLVD
Practice Address - Street 2:BUILDING 300A
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606
Practice Address - Country:US
Practice Address - Phone:757-595-4300
Practice Address - Fax:757-591-9297
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2012-09-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101252641207RE0101X
TXBP1-0027842390200000X
CAA110936390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program