Provider Demographics
NPI:1427102409
Name:RITCHIE, AGATHA T (PA)
Entity type:Individual
Prefix:
First Name:AGATHA
Middle Name:T
Last Name:RITCHIE
Suffix:
Gender:F
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:PO BOX 33440
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06150-3440
Mailing Address - Country:US
Mailing Address - Phone:860-522-7181
Mailing Address - Fax:860-278-3357
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:SUITE 325
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5501
Practice Address - Country:US
Practice Address - Phone:860-522-7181
Practice Address - Fax:860-278-3357
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
001368363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT011368OtherCONNECTICARE
CTOV3419OtherHEALTHNET OF NE
CTP00137575OtherRAILROAD MEDICARE
CTP3288442OtherOXFORD HEALTHPLAN
CT290001368CT01OtherBLUE CROSS BLUE SHIELD CT
CTOV3419OtherHEALTHNET OF NE
CTQ04762Medicare UPIN