Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 12317 | NH |
N | 111NI0900X | Internist | 12317 | NH |
Y | 208000000X | Pediatrician | 12317 | NH |
NPI | 1013007301 |
---|---|
Provider Name | Christopher Michael Riccio |
First Address | Nashua, NH 03061-3677 |
Second Address | Nashua, NH 03060-3923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2006 |
Last Update Date | 22/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30204320 | (05) | NH |
I09678 | (02) | NH |