Provider Demographics
NPI:1154384832
Name:RICKETTS, ANTHONY DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:DAVID
Last Name:RICKETTS
Suffix:
Gender:M
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:PO BOX 7462
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00823-7462
Mailing Address - Country:US
Mailing Address - Phone:340-719-0681
Mailing Address - Fax:340-719-9023
Practice Address - Street 1:SUITE 4F/5F SUNNY ISLE PROFESSIONAL BUILDING
Practice Address - Street 2:SUNNY ISLE
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820
Practice Address - Country:US
Practice Address - Phone:340-719-0681
Practice Address - Fax:340-719-9039
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1103208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics