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NPI Code Detail

MEDICARE: DENIS P RICARD PA

MEDICARE: DENIS P RICARD PA
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
1363A00000XPhysician Assistant101360NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1902898414
Entity Type Code : Individual
Provider Name (Legal Business Name) : DENIS P RICARD PA
Provider Business Mailing Address
First Line : 60 COMMERCE PLAZA CIR
Second Line :
City : PEMBROKE
State : NC
Zip : 28372-7386
Country : US
Telephone Number : 910-521-2900
Fax Number : 910-775-9165
Provider Business Practice Location Address
First Line : 1212 S WALNUT ST
Second Line :
City : FAIRMONT
State : NC
Zip : 28340-1848
Country : US
Telephone Number : 910-628-6711
Fax Number : 910-628-5735
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2005
Last Update Date : 09/16/2020

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Directions to “ DENIS P RICARD PA” Practice Location

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