Provider Demographics
NPI:1629094776
Name:RUGGIERO, DOMINICK A (PA-C)
Entity Type:Individual
Prefix:
First Name:DOMINICK
Middle Name:A
Last Name:RUGGIERO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7068
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-0068
Mailing Address - Country:US
Mailing Address - Phone:757-547-9294
Mailing Address - Fax:757-213-9342
Practice Address - Street 1:612 KINGSBOROUGH SQ STE 100
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-5041
Practice Address - Country:US
Practice Address - Phone:757-547-9294
Practice Address - Fax:757-213-9342
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110002303363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant