Provider Demographics
NPI:1245418722
Name:RIVARD, THERESE P (PA)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:P
Last Name:RIVARD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:THERESE
Other - Middle Name:
Other - Last Name:PIACENTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2800 BLUE RIDGE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6477
Mailing Address - Country:US
Mailing Address - Phone:919-784-7110
Mailing Address - Fax:919-784-7111
Practice Address - Street 1:2800 BLUE RIDGE RD STE 201
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6477
Practice Address - Country:US
Practice Address - Phone:919-784-7110
Practice Address - Fax:919-784-7111
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC180313363A00000X
MA1980363AS0400X
VT055.0031325363AS0400X
NC0010-03434363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical