Provider Demographics
NPI:1538120548
Name:GILLESPIE, RITCHIE P (MD)
Entity Type:Individual
Prefix:
First Name:RITCHIE
Middle Name:P
Last Name:GILLESPIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 S MAIN ST
Mailing Address - Street 2:STE A
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-3051
Mailing Address - Country:US
Mailing Address - Phone:540-434-7749
Mailing Address - Fax:540-434-7793
Practice Address - Street 1:1320 S MAIN ST
Practice Address - Street 2:STE A
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-3051
Practice Address - Country:US
Practice Address - Phone:540-434-7749
Practice Address - Fax:540-434-7793
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010422099174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6154531Medicaid
VAC96073Medicare UPIN