Provider Demographics
NPI:1083613509
Name:RICCIO, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:RICCIO
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 1:9 WASHINGTON AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3267
Mailing Address - Country:US
Mailing Address - Phone:203-248-3013
Mailing Address - Fax:203-248-2878
Practice Address - Street 1:310 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06512-2919
Practice Address - Country:US
Practice Address - Phone:203-467-1800
Practice Address - Fax:203-468-8343
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT022540207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT110179063OtherRAILROAD MEDICARE
CT010022540CT01OtherBLUE CROSS BLUE SHIELD
CT022540OtherCONNECTICARE
CT2047711OtherAETNA
CTNHP075OtherOXFORD
CT0Q2055OtherHEALTH NET
CT2047711OtherAETNA
CT110006907Medicare ID - Type Unspecified