Provider Demographics
NPI:1326581232
Name:RIDOLFI, NICHOLAS JOSEPH (PA-C)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:JOSEPH
Last Name:RIDOLFI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1771 N PIERCE ST APT 412
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-1832
Mailing Address - Country:US
Mailing Address - Phone:609-634-8672
Mailing Address - Fax:
Practice Address - Street 1:2800 S SHIRLINGTON RD FL 11
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22206-3601
Practice Address - Country:US
Practice Address - Phone:703-892-6500
Practice Address - Fax:703-892-4197
Is Sole Proprietor?:No
Enumeration Date:2016-11-25
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA058640363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant