Provider Demographics
NPI:1124557913
Name:RIDEOUT, CODY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CODY
Middle Name:
Last Name:RIDEOUT
Suffix:
Gender:M
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 1:14 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:GILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03249-6580
Mailing Address - Country:US
Mailing Address - Phone:603-528-9100
Mailing Address - Fax:603-524-5743
Practice Address - Street 1:14 MAPLE ST
Practice Address - Street 2:
Practice Address - City:GILFORD
Practice Address - State:NH
Practice Address - Zip Code:03249-6580
Practice Address - Country:US
Practice Address - Phone:603-528-9100
Practice Address - Fax:603-524-5743
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH363AS0400X
NH1217363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical