Provider Demographics
NPI:1194713545
Name:PASQUARELLA, RICHARD ARTHUR JR (PA-C)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ARTHUR
Last Name:PASQUARELLA
Suffix:JR
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:2550 UNIVERSITY AVE W
Mailing Address - Street 2:SUITE 240N
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1052
Mailing Address - Country:US
Mailing Address - Phone:651-999-6909
Mailing Address - Fax:651-297-6115
Practice Address - Street 1:360 SHERMAN ST
Practice Address - Street 2:SUITE 450
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2564
Practice Address - Country:US
Practice Address - Phone:651-999-6800
Practice Address - Fax:651-999-6808
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2016-04-27
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Provider Licenses
StateLicense IDTaxonomies
MN9266363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN265710400Medicaid
MNS69462Medicare UPIN
MN970001282Medicare ID - Type Unspecified