Provider Demographics
NPI:1063041457
Name:RITTER, MOLLY (PA-C)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:RITTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 WOODBOURNE AVE APT 13
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-1752
Mailing Address - Country:US
Mailing Address - Phone:502-550-6524
Mailing Address - Fax:
Practice Address - Street 1:27 OAK ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5342
Practice Address - Country:US
Practice Address - Phone:203-359-4888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program