Provider Demographics
NPI:1497724322
Name:RICKEL, RALPH ELLSWORTH JR (MD, FAAFM)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:ELLSWORTH
Last Name:RICKEL
Suffix:JR
Gender:M
Credentials:MD, FAAFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1146
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25402-1146
Mailing Address - Country:US
Mailing Address - Phone:540-869-0600
Mailing Address - Fax:
Practice Address - Street 1:1330 AMHERST ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3000
Practice Address - Country:US
Practice Address - Phone:540-722-2369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101051674207Q00000X
WV13077207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A72199Medicare UPIN