Provider Demographics
NPI:1871721456
Name:ANDO, RICCA AIMEE (DO)
Entity type:Individual
Prefix:DR
First Name:RICCA
Middle Name:AIMEE
Last Name:ANDO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4623 SPRUCE STREET
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-4542
Mailing Address - Country:US
Mailing Address - Phone:215-474-6100
Mailing Address - Fax:
Practice Address - Street 1:4623 SPRUCE STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-4542
Practice Address - Country:US
Practice Address - Phone:215-474-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT012823207Q00000X
PAOS015497207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine