Healthcare Provider Details

I. General information

NPI: 1356082861
Provider Name (Legal Business Name): ANGELA RYCK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 LEE ST
CHARLOTTESVILLE VA
22908
US

IV. Provider business mailing address

1215 LEE ST MAILBOX 801007
CHARLOTTESVILLE VA
22908-0816
US

V. Phone/Fax

Practice location:
  • Phone: 434-243-5600
  • Fax:
Mailing address:
  • Phone: 434-243-5600
  • Fax: 434-244-9450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116037530
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: