Provider Demographics
NPI:1932239381
Name:RICKER, MELINDA (PA-C)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:RICKER
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 1:100 E CARROLL ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5422
Mailing Address - Country:US
Mailing Address - Phone:410-543-7531
Mailing Address - Fax:410-912-6386
Practice Address - Street 1:30265 COMMERCE DR
Practice Address - Street 2:SUITE 207
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-3593
Practice Address - Country:US
Practice Address - Phone:302-732-8400
Practice Address - Fax:302-934-6705
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC50000256363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEP33773Medicare UPIN