Healthcare Provider Details

I. General information

NPI: 1912688599
Provider Name (Legal Business Name): RICHARD ALAN RIDGE SR. RN, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 HUNTLEY AVE
CHARLOTTESVILLE VA
22903-3276
US

IV. Provider business mailing address

307 HUNTLEY AVE
CHARLOTTESVILLE VA
22903-3276
US

V. Phone/Fax

Practice location:
  • Phone: 434-953-1290
  • Fax:
Mailing address:
  • Phone: 434-953-1290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001132290
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024194322
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: