Provider Demographics
NPI:1144439910
Name:RICCARDI, DAVID D
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:D
Last Name:RICCARDI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 PEACH ST
Mailing Address - Street 2:SUITE #95
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-2109
Mailing Address - Country:US
Mailing Address - Phone:814-459-2350
Mailing Address - Fax:814-459-7510
Practice Address - Street 1:1611 PEACH ST
Practice Address - Street 2:SUITE #95
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-2109
Practice Address - Country:US
Practice Address - Phone:814-459-2350
Practice Address - Fax:814-459-7510
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAF02127237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA204228Medicare PIN