Provider Demographics
NPI:1528067519
Name:RICCI, DANIEL MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:MICHAEL
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:PO BOX 968
Mailing Address - Street 2:
Mailing Address - City:WALLACE
Mailing Address - State:NC
Mailing Address - Zip Code:28466-0968
Mailing Address - Country:US
Mailing Address - Phone:910-285-4100
Mailing Address - Fax:910-285-4766
Practice Address - Street 1:207 E MURPHY ST
Practice Address - Street 2:
Practice Address - City:WALLACE
Practice Address - State:NC
Practice Address - Zip Code:28466-1946
Practice Address - Country:US
Practice Address - Phone:910-285-4100
Practice Address - Fax:910-285-4766
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30463207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC71519OtherBCBS
NC29856OtherMEDCOST
NC71519OtherBCBS
NCC86141Medicare UPIN
NCC86141Medicare UPIN