Provider Demographics
NPI:1326222928
Name:RICKETTS, PAUL ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ANDREW
Last Name:RICKETTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:113 GAINSBOROUGH SQ STE 101
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-1713
Mailing Address - Country:US
Mailing Address - Phone:757-436-3285
Mailing Address - Fax:757-436-2262
Practice Address - Street 1:113 GAINSBOROUGH SQ STE 202
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-1714
Practice Address - Country:US
Practice Address - Phone:757-627-6416
Practice Address - Fax:757-627-3709
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036122994207RG0100X
VA0101251578207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology