Healthcare Provider Details

I. General information

NPI: 1538123146
Provider Name (Legal Business Name): RICHELLE L HEALEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 01/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 PHILLIP MORRIS DR
SALISBURY MD
21804-1923
US

IV. Provider business mailing address

PO BOX 1978
SALISBURY MD
21802-1978
US

V. Phone/Fax

Practice location:
  • Phone: 410-546-2424
  • Fax: 410-742-6633
Mailing address:
  • Phone: 410-749-1015
  • Fax: 410-749-0654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0001814
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: