Healthcare Provider Details

I. General information

NPI: 1841232303
Provider Name (Legal Business Name): MORIAH B RITSON PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MORIAH BASS PA

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 GRAPE ST
NEW BEDFORD MA
02740-2143
US

IV. Provider business mailing address

244 MAIN STREET ANNEX P.O. BOX 32
NORTHAMPTON MA
01061-0032
US

V. Phone/Fax

Practice location:
  • Phone: 774-202-2264
  • Fax: 413-341-1789
Mailing address:
  • Phone: 413-727-3534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number000061
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: