Glenn Michael Riccio, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0110007920 Issued in VA

Practice address

365 Tyler Dr
Clear Brook, VA 22624-1662

Phone

(434) 326-2164

NPI assigned

Jun 10, 2021

Last updated

Jun 10, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1623283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623283200000",
    "number": "1366019085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "365 TYLER DR",
            "city": "CLEAR BROOK",
            "state": "VA",
            "postal_code": "226241662",
            "telephone_number": "434-326-2164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "365 TYLER DR",
            "city": "CLEAR BROOK",
            "state": "VA",
            "postal_code": "226241662",
            "telephone_number": "434-326-2164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICCIO",
        "first_name": "GLENN",
        "middle_name": "MICHAEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-10",
        "last_updated": "2021-06-10",
        "certification_date": "2021-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110007920",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Jennifer Winslow

• Physician Assistant in Clear Brook, VA
• Providers in Clear Brook, VA by specialty
• Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.