MEDICARE: DR. THADDEUS RITCH DE HERRERA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	25MA0929600	NJ
2	207Q00000X	Family Medicine Physician	MD478812	PA
3	207R00000X	Internal Medicine Physician	MD2011-0549	NM
4	207Q00000X	Family Medicine Physician	MD2011-0549	NM
5	2083X0100X	Occupational Medicine Physician	25MA09296000	NJ
6	2083X0100X	Occupational Medicine Physician	MD478812	PA

General Provider Information

NPI Number	:	1801063714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THADDEUS RITCH DE HERRERA M.D.

Provider Business Mailing Address
First Line	:	5080 SPECTRUM DR STE 1200W
Second Line	:
City	:	ADDISON
State	:	TX
Zip	:	75001-4624
Country	:	US
Telephone Number	:	972-364-8083
Fax Number	:	147-754-5022

Provider Business Practice Location Address
First Line	:	2804 SOUTHAMPTON RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19154-1207
Country	:	US
Telephone Number	:	215-677-0930
Fax Number	:	215-677-3266

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2008
Last Update Date	:	01/15/2024

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