Provider Demographics
NPI:1649205246
Name:RICKARDS, JOSHUA THOMAS (PA)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:THOMAS
Last Name:RICKARDS
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 1:1579 STRAITS TPKE STE E
Mailing Address - Street 2:ORTHOPAEDICS NEW ENGLAND PC
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762-1835
Mailing Address - Country:US
Mailing Address - Phone:203-598-0700
Mailing Address - Fax:877-345-6922
Practice Address - Street 1:1579 STRAITS TPKE STE E
Practice Address - Street 2:ORTHOPAEDICS NEW ENGLAND PC
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762-1835
Practice Address - Country:US
Practice Address - Phone:203-598-0700
Practice Address - Fax:877-345-6922
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001716363A00000X, 363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT003017167Medicaid
CTPENDINGOtherRR MEDICARE
CT003017167Medicaid
CT970002038Medicare PIN