Provider Demographics
NPI:1619038270
Name:RICARD, LAURA ANN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ANN
Last Name:RICARD
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 1:1760 OLD MEADOW RD STE 500
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-4306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8180 GREENSBORO DR
Practice Address - Street 2:STE 300
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-3888
Practice Address - Country:US
Practice Address - Phone:703-810-5217
Practice Address - Fax:703-810-5423
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1871363AM0700X
DCPA030418363AM0700X
VA0110002487363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical