1134189301 NPI number — DR. CHRISTINE DARAGJATI RICCARDI M.D.

Table of content: DR. CHRISTINE DARAGJATI RICCARDI M.D. (NPI 1134189301)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134189301 NPI number — DR. CHRISTINE DARAGJATI RICCARDI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICCARDI
Provider First Name:
CHRISTINE
Provider Middle Name:
DARAGJATI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DARAGJATI
Provider Other First Name:
CHRISTINE
Provider Other Middle Name:
HELEN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134189301
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 WATER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAVERHILL
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01830-6229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-373-6557
Provider Business Mailing Address Fax Number:
978-374-5096

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 WATER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAVERHILL
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01830-6229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-373-6557
Provider Business Practice Location Address Fax Number:
978-374-5096
Provider Enumeration Date:
03/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  232828 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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