Provider Demographics
NPI:1366974453
Name:RICCIO, ANGELA (DO)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:RICCIO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 BILL DALRYMPLE RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NC
Mailing Address - Zip Code:28734-7869
Mailing Address - Country:US
Mailing Address - Phone:908-616-2699
Mailing Address - Fax:
Practice Address - Street 1:55 HOLLY SPRINGS PARK DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NC
Practice Address - Zip Code:28734-0719
Practice Address - Country:US
Practice Address - Phone:828-349-3550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC226825207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program