Individual provider · Type 1 NPI

Cleveland Samuel Ricketts, MD

Student in an Organized Health Care Education/Training Program · Boston, MA

NPI number 1043915424 Active · reactivated Aug 11, 2025

Practice location

330 Brookline Avenue
Boston, MA 02215

Call (617) 667-7000 Map

Mailing address

138 Laughlin
East Stratford, CT 06614

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: 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.

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About NPI 1043915424

Cleveland Samuel Ricketts, MD's National Provider Identifier is 1043915424, issued on Apr 4, 2023. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Boston, MA. The record was last updated on Aug 11, 2025.