Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD19246 | ME |
Y | 208600000X | Surgeon | MD19246 | ME |
N | 2086S0102X | Surgical Critical Care | MD19246 | ME |
N | 2086S0129X | Vascular Surgeon | MD19246 | ME |
NPI | 1326010695 |
---|---|
Provider Name | Dr. Michael Anthony Ricci |
First Address | Lewiston, ME 04240 |
Second Address | Lewiston, ME 04240 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2006 |
Last Update Date | 11/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
VT922302 | (02) | ME |
VT922303 | (02) | ME |
VT922304 | (02) | ME |
VT922305 | (02) | ME |