Provider Demographics
NPI:1215187794
Name:PLATA, RICARDO (PA-C)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:PLATA
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:PO BOX 412503
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-2503
Mailing Address - Country:US
Mailing Address - Phone:207-384-4949
Mailing Address - Fax:207-384-4273
Practice Address - Street 1:31 COLCORD ST
Practice Address - Street 2:
Practice Address - City:SOUTH BERWICK
Practice Address - State:ME
Practice Address - Zip Code:03908-1004
Practice Address - Country:US
Practice Address - Phone:207-384-4949
Practice Address - Fax:207-384-4273
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1652363A00000X
MEPA2118363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3125195Medicaid