Provider Demographics
NPI:1235111303
Name:RICARD, A. MICHELE (MD)
Entity Type:Individual
Prefix:
First Name:A.
Middle Name:MICHELE
Last Name:RICARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:MICHELE
Other - Last Name:RICARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1070
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MA
Mailing Address - Zip Code:01503-2070
Mailing Address - Country:US
Mailing Address - Phone:978-771-2343
Mailing Address - Fax:
Practice Address - Street 1:124 PLEASANT STREET
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MA
Practice Address - Zip Code:01503-2070
Practice Address - Country:US
Practice Address - Phone:978-771-2343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA38517207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
042472266OtherPRIVATE HEALTHCARE SYSTEM
042472266008OtherTRICARE/CHAMPUS
45519OtherHEALTHY START
4582679OtherAETNA/US HEALTHCARE
784076OtherMVP HEALTH CARE
0101699OtherMEDICAID/WELFARE
B22015OtherMEDICARE B
0404598OtherEVERCARE
042472266OtherONE HEALTH PLAN
380001952OtherRAILROAD MEDICARE
45519OtherCHILDRENS MED SECURITY PL
4768OtherFALLON COMMUNITY HLTH PL
042472266OtherTHREE RIVERS
2105073OtherFIRST HEALTH
AA2365OtherHARVARD PILGRIM HEALTHCAR
B22015OtherBLUE SHIELD HMO BLUE
B22015OtherBLUE CARE ELECT
B22015OtherBLUE SHIELD INDEMNITY
45519OtherHEALTHY START
B22015OtherBLUE CARE ELECT