Provider Demographics
NPI:1144569732
Name:RITCH, LYLE JOSEPH (PA)
Entity Type:Individual
Prefix:
First Name:LYLE
Middle Name:JOSEPH
Last Name:RITCH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17704 GREENLEAF PL
Mailing Address - Street 2:
Mailing Address - City:ROUND HILL
Mailing Address - State:VA
Mailing Address - Zip Code:20141-2272
Mailing Address - Country:US
Mailing Address - Phone:571-395-1030
Mailing Address - Fax:571-395-1030
Practice Address - Street 1:1850 TOWN CENTER PKWY STE 550
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3300
Practice Address - Country:US
Practice Address - Phone:703-876-4270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110004155363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant