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NPI Code Detail

MEDICARE: RITA THERESA HARTY MS PA-C

MEDICARE: RITA THERESA HARTY MS PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant25MP00204300NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
125MP00204300OTHERNJNJ LICENSE NUMBER
2PA 9109246OTHERFLPA LICENSE

General Provider Information

NPI Number : 1407134000
Entity Type Code : Individual
Provider Name (Legal Business Name) : RITA THERESA HARTY MS PA-C
Provider Business Mailing Address
First Line : 5000 COX RD
Second Line :
City : GLEN ALLEN
State : VA
Zip : 23060-9263
Country : US
Telephone Number : 804-822-4355
Fax Number :
Provider Business Practice Location Address
First Line : 4000 ROUTE 130
Second Line :
City : DELRAN
State : NJ
Zip : 08075-2414
Country : US
Telephone Number : 856-705-0685
Fax Number : 727-210-4600
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2011
Last Update Date : 02/07/2022

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