Provider Demographics
NPI:1861493942
Name:RITCHISON, LINDA SUZANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:SUZANNE
Last Name:RITCHISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8051 SOUTH EMERSON AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-8632
Mailing Address - Country:US
Mailing Address - Phone:317-865-2955
Mailing Address - Fax:317-865-2944
Practice Address - Street 1:8051 SOUTH EMERSON AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8632
Practice Address - Country:US
Practice Address - Phone:317-865-2955
Practice Address - Fax:317-865-2944
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28110334363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200323730Medicaid
066980OMedicare PIN
IN066980OMedicare PIN
IN200323730Medicaid
INS84005Medicare PIN