Provider Demographics
NPI:1528194552
Name:MOFFITT, RICK (PA)
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:
Last Name:MOFFITT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 MARTINE ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02723-1516
Mailing Address - Country:US
Mailing Address - Phone:508-675-4683
Mailing Address - Fax:508-675-7905
Practice Address - Street 1:100 KENYON AVE
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-4216
Practice Address - Country:US
Practice Address - Phone:401-782-8010
Practice Address - Fax:508-675-7905
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00003363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI30597OtherBCBS RI
RI408389OtherBLUE CHIP
RI7008700Medicaid
RI7008700Medicaid