| Doctor Name: | DR. MARICEL LILIAN RIDELLA |
| NPI Number: | 1740472646 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MD |
| License Number: | BP1-0027842 |
| Business Practice Address: | 704 Thimble Shoals Blvd Building 300a Newport News, VA - 23606 |
| Business Phone Number: | 7575954300 |
| Business Fax Number: | 7575919297 |
| Mailing Address: | 860 Omni Blvd, Suite 303 NEWPORT |
| State: | VA |
| Postal Code: | 236621027 |
| Phone Number: | 7572328769 |
| Fax Number: | 7572328875 |
| NPI Enumeration Date: | 08/14/2007 |
| NPI Last Update Date: | 09/04/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | BP1-0027842 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TX |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |