Provider Demographics
NPI:1801906334
Name:RICCI, ANTHONY T (DC)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:T
Last Name:RICCI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 WEST ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-4055
Mailing Address - Country:US
Mailing Address - Phone:410-263-6331
Mailing Address - Fax:410-280-9886
Practice Address - Street 1:1610 WEST ST
Practice Address - Street 2:SUITE 110
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-4055
Practice Address - Country:US
Practice Address - Phone:410-263-6331
Practice Address - Fax:410-280-9886
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1542 PT111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD292468OtherALLIANCE PROIDER ID
MD6074299OtherCIGNA PROVIDER ID
MDLP84ANOtherCAREFIRST BCBS PROV. ID
MD086650000OtherPREF HEALTH NET PROV. ID
MD1623373OtherUHC PROVIDER ID
MD293065600OtherUS DEPT LABOR PROV. ID
MD5856209OtherAETNA PROVIDER ID
MDR6170002OtherFEDERAL BCBS PROV. ID
MD293065600OtherUS DEPT LABOR PROV. ID
MD5856209OtherAETNA PROVIDER ID
MDR6170002OtherFEDERAL BCBS PROV. ID