Provider Demographics
NPI:1528082559
Name:RIFICI, JOSEPH M (AA)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
Last Name:RIFICI
Suffix:
Gender:M
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:216-383-6614
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH67-000021367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7764013OtherAETNA
OHP00839055OtherMEDICARE RAILROAD
OH0583328OtherBCMH
OH2491585Medicaid
OH415025OtherWELLCARE MEDICAID
OH000000232314OtherUNISON
OH000000515972OtherANTHEM
OH50045372OtherRAILROAD MEDICARE
OH000000515972OtherANTHEM
OHRI8239411Medicare PIN