Provider Demographics
NPI:1538123146
Name:HEALEY, RICHELLE L (PA-C)
Entity Type:Individual
Prefix:
First Name:RICHELLE
Middle Name:L
Last Name:HEALEY
Suffix:
Gender:F
Credentials:PA-C
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 1978
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21802-1978
Mailing Address - Country:US
Mailing Address - Phone:410-749-1015
Mailing Address - Fax:410-749-0654
Practice Address - Street 1:223 PHILLIP MORRIS DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-1923
Practice Address - Country:US
Practice Address - Phone:410-546-2424
Practice Address - Fax:410-742-6633
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0001814363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119591300Medicaid
P31213Medicare UPIN
MD119591300Medicaid
MD211863Medicare Oscar/Certification
MDK519J457Medicare ID - Type Unspecified