Provider Demographics
NPI:1477579761
Name:RICOTTA, PATRICK J (DPM)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:J
Last Name:RICOTTA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:FOOT AND ANKLE
Other - Middle Name:INSTITUTE OF ROBESON
Other - Last Name:COUNTY, INC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 40908
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28309-0908
Mailing Address - Country:US
Mailing Address - Phone:910-615-6949
Mailing Address - Fax:910-615-9761
Practice Address - Street 1:815 WESLEY PINES RD.
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2359
Practice Address - Country:US
Practice Address - Phone:910-737-6600
Practice Address - Fax:910-737-6532
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC392213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCU63282Medicare UPIN
NC4710480002Medicare NSC