Healthcare Provider Details

I. General information

NPI: 1760074595
Provider Name (Legal Business Name): GINA A RICART
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 MAIN ST
CHARLESTOWN MA
02129-1125
US

IV. Provider business mailing address

6 COGSWELL AVE
HAVERHILL MA
01835-7309
US

V. Phone/Fax

Practice location:
  • Phone: 866-610-2273
  • Fax:
Mailing address:
  • Phone: 978-771-1871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2274408
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: