Basic Information
| Provider Information | |||||||||
| NPI: | 1619324902 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RICCI | ||||||||
| FirstName: | JEREC | ||||||||
| MiddleName: | WARREN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 35 FOLLY ROAD BLVD APT 368 | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294077506 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 96 JONATHAN LUCAS ST | ||||||||
| Address2: | SUITE 420 | ||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294258900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437923072 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2016 | ||||||||
| LastUpdateDate: | 05/17/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 39385 | SC | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.