Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 010123294 | VA |
N | 208600000X | Surgeon | 010123294 | VA |
N | 2086S0102X | Surgical Critical Care | 0101232194 | VA |
N | 2086S0120X | Pediatric Surgery | 0101232194 | VA |
Y | 2086S0120X | Pediatric Surgery | 83998 | SC |
NPI | 1053391227 |
---|---|
Provider Name | Dr. Robert Louis Ricca JR. |
First Address | Greenville, SC 29601-2842 |
Second Address | Greenville, SC 29605-4263 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2006 |
Last Update Date | 08/06/2021 |